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Advanced Solid TumoursPhase 2KEYNOTE-E86NCT04907851

A Study to Assess RXC004 Efficacy in Advanced Solid Tumours After Progression on Standard of Care (SoC) Therapy (PORCUPINE2)

A Phase 2 study testing RXC004, Denosumab and pembrolizumab in people with Advanced Solid Tumours, run by Redx Pharma Ltd at 13 sites in 2 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This study is to evaluate the preliminary efficacy and safety of RXC004 monotherapy and in combination with pembrolizumab in advanced solid tumours that have progressed following SoC treatment. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Advanced Solid Tumours
What is being tested?
RXC004, Denosumab and pembrolizumab
Could I receive a placebo?
No, everyone receives an active treatment
How many people
45 participants
Where
13 sitesin 2 countries
Study dates
10 Dec 2021to 30 Nov 2023
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

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

Core Inclusion Criteria:

  • At least one lesion that is measurable by RECIST 1.1 at baseline (within 6 weeks prior to start of study treatment).
  • Mandatory paired biopsies; Patients must have at least one lesion suitable for biopsy at screening
  • Adequate organ and marrow function
  • Female patients of childbearing potential must have a negative pregnancy test prior to start of dosing
  • Female patients of childbearing potential and male patients with female partners of childbearing potential must agree to use a highly effective method of contraception during the study from the time of treatment initiation, and for at least 5 months after the last dose of study drug.

Module 1 (PDAC) Specific Inclusion Criteria

  • Histological documentation of advanced (unresectable)/metastatic (Stage III/IV) PDAC, with documented loss of function tumour mutation in RNF43
  • Patients must have received one prior systemic treatment for advanced (unresectable)/metastatic PDAC (Stage III/IV), with clear evidence of radiological disease progression
  • Patients must be enrolled and receive first dose of study treatment within 6 weeks of radiologically confirmed progression
  • Karnofsky performance status ≥70.

Module 2 and Module 3 (BTC) Specific Inclusion Criteria

  • Histological documentation of advanced (unresectable)/metastatic (Stage III/IV) BTC (intrahepatic or extrahepatic cholangiocarcinoma, ampulla of Vater, or gallbladder cancer)
  • Patients must have received one prior systemic treatment for advanced (unresectable)/metastatic BTC, with clear evidence of radiological disease progression
  • Patients must be enrolled and receive first dose of study treatment within 6 weeks of radiologically confirmed progression
  • ECOG status 0 or 1.

Core Exclusion Criteria:

  • Prior therapy with a compound of the same mechanism of action as RXC004
  • Patients at higher risk of bone fractures
  • Any known uncontrolled inter-current illness or persistent clinically significant toxicity related to prior anti-cancer treatment
  • Patients who have any history of an active (requiring treatment) other malignancy within 2 years of study entry
  • Patients with known or suspected brain metastases
  • Use of anti-neoplastic agents
  • Patients with a known hypersensitivity to any RXC004 excipients
  • Patients with a contra-indication for denosumab treatment
  • Patients who are pregnant or breast-feeding
  • Known active human immunodeficiency viruses (HIV), hepatitis B (HBV), or hepatitis C (HCV) infections
  • Use of any live or live-attenuated vaccines against infectious diseases (e.g., influenza nasal spray, varicella) within 4 weeks (28 days) of initiation of study treatment
  • Mean resting corrected QTcF >470 ms, obtained from triplicate ECGs performed at screening.

There are no exclusion criteria specific to Modules 1 and 2.

Module 3 Specific Exclusion Criteria:

  • Patients with any contraindication to the use of pembrolizumab as per approved label
  • Has received prior therapy with an anti-programmed cell death-1 (anti-PD-1), anti-PD-L1, or anti-PD-L2 agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor, and was discontinued from that treatment due to a Grade 3 or higher AE
  • Has received prior radiotherapy within 2 weeks of start of study treatment or have had a history of radiation pneumonitis
  • Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior the first dose of pembrolizumab in this study
  • Has severe hypersensitivity (≥ Grade 3) to pembrolizumab and/or any of its excipients
  • Has an active autoimmune disease that has required systemic treatment in past 2 years
  • Has a history of (non-infectious) pneumonitis / interstitial lung disease that required steroids or has current pneumonitis / interstitial lung disease
  • Has an active infection requiring systemic therapy
  • Patients with a history of allogeneic tissue/solid organ transplant
  • Patients with active infections, including tuberculosis, HIV, HBV, or HCV

Trial locations and contacts

13 sites in 2 countries.

13 sites in 2 countries

United Kingdom11 sites
  • Cambridge University Hospital NHS Foundation Trust

    Cambridge, CB2 0XY

  • Beatson West of Scotland Cancer Care

    Glasgow, G12 0YN

  • St James University Hospital

    Leeds, LS9 7TF

  • Barts Cancer Institute - Haemato-Oncology

    London, EC1M 6BQ

  • University College Hospitals NHS Foundation Trust

    London, NW1 2BU

  • Royal Free London Foundation NHS Trust

    London, NW3 2QG

  • Imperial College Healthcare NHS Trust - Hammersmith Hospital

    London, W12 0HS

  • The Christie NHS Foundation Trust - Medical Oncology

    Manchester, M20 4BX

  • Oxford Cancer and Haematology Centre Churchill Hospital

    Oxford, OX3 7LE

  • Weston Park Hospital

    Sheffield, S10 2SJ

  • The Royal Marsden Hospital (Surrey)

    Sutton, SM25PT

Other trials in United Kingdom

Australia2 sites
  • The Alfred Hospital - Alfred Health

    Melbourne, Victoria, 3304

  • Wollongong Hospital

    Wollongong, New South Wales, 2500

Other trials in Australia

About this study

Official title: A Modular, Phase II, Open-Label, Multicentre Study to Assess the Preliminary Efficacy and Safety of RXC004, in Patients With Advanced Solid Tumours That Have Progressed Following Therapy With Current Standard of Care

This study is to evaluate the preliminary efficacy and safety of RXC004 monotherapy and in combination with pembrolizumab in advanced solid tumours that have progressed following SoC treatment.

Read the detailed description

This Phase II, modular, open label, multicentre study initially opened with ring finger protein 43 (RNF43) loss of function (LoF) mutation-positive pancreatic ductal adenocarcinoma (PDAC) (Module 1) and molecularly unselected biliary tract cancer (BTC) (Module 2) modules. Module 3 will investigate RXC004 in combination with pembrolizumab in BTC. Modules 1 and 2 are monotherapies and Module 3 is the combination therapy.

The primary objective of the study is to assess the preliminary efficacy of RXC004 in each module. This will be evaluated in terms of progression free survival (PFS) at 6 months in Modules 1 and 2, and in terms of Objective response rate (ORR) in Module 3. Following radiological progression, patients will be followed-up for survival.

Being tested
RXC004, Denosumab, pembrolizumab
Keywords
Open-Label, RXC004, Ring finger protein 43, Pancreatic ductal adenocarcinoma, Biliary tract cancer, Efficacy, Safety, Pharmacokinetics, Pancreatic cancer, Cholangiocarcinoma, Gallbladder, Ampullary Cancer, Ampulla of Vater, MK-3475-E86, zamaporvint
Medical subject headings
Biliary Tract Neoplasms, Pancreatic Neoplasms, Cholangiocarcinoma

What participants receive

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

  • RXC004Drug

    Also called zamaporvint

    RXC004 will be administered orally, 2 mg QD; Dose Formulation: 0.5 mg or 1 mg capsules.

  • RXC004Drug

    Also called zamaporvint

    RXC004 will be administered orally, 2 mg QD (Cohort 1, Module 2) and 1 mg QD (Cohort 2, Module 2); Dose Formulation: 0.5 mg or 1 mg capsules.

  • RXC004Drug

    Also called zamaporvint

    RXC004 will be administered orally, 1.5 mg QD; Dose Formulation: 0.5 mg or 1 mg capsules.

  • DenosumabBiological

    Denosumab will be administered via subcutaneous (SC) injection, 120 mg once every month; Use: Prophylactic

  • pembrolizumabBiological

    Also called KEYTRUDA®

    Pembrolizumab will be administered via intravenous infusion, 400 mg dose once every 6 weeks

Study groups in NCT04907851
Study groupRoleWhat they receive
Module 1 - RNF43 Mutated Advanced (unresectable)/Metastatic Pancreatic Cancer (Stage III/IV)ExperimentalPatients (Karnofsky performance status ≥70) will be recruited and dosed with RXC004 (2 mg once daily [QD], orally) within 6 weeks of progression following 1st line SoC treatment.
Receives: Drug: RXC004; Biological: Denosumab
Module 2 -Advanced (unresectable)/Metastatic Biliary Tract Cancer (Stage III/IV)ExperimentalPatients (Eastern Cooperative Oncology Group [ECOG] performance status 0-1) will be recruited and dosed with RXC004 within 6 weeks of progression, following 1st line SoC treatment.
Receives: Drug: RXC004; Biological: Denosumab
Module 3-Advanced (unresectable)/Metastatic Biliary Tract Cancer (Stage Ill/IV) Combination TherapyExperimentalPatients (ECOG performance status 0-1) will be recruited and dosed with RXC004 (1.5 mg QD, orally) in combination with pembrolizumab 400 mg IV infusion every 6 weeks (q6w) within 6 weeks of progression, following 1st line Soc treatment.
Receives: Drug: RXC004; Biological: Denosumab; Biological: pembrolizumab

What is being measured

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

  1. Monotherapy (Modules 1 and 2): Progression Free Survival Rate at 6 Months

    The anti-tumour activity of RXC004 was assessed. Progression free survival rate at 6 months was defined as the percentage of patients who remained alive and free of progression at 6 months according to Kaplan-Meier estimates.

    Measured: At 6 months

  2. Combination Therapy (Module 3): Objective Response Rate (ORR)

    The anti-tumour activity of RXC004 as a combination therapy was assessed. ORR was defined as the percentage of patients with a best overall response of complete response or partial response based on local investigator assessment as defined in RECIST 1.1.

    Measured: Up to 23 months

Secondary outcomes (14)
  1. Monotherapy (Modules 1 and 2): ORR

    The preliminary efficacy of RXC004 was assessed. ORR was defined as the percentage of patients with a best overall response of complete response (CR) or partial response (PR) based on local Investigator assessment as defined in RECIST 1.1.

    Measured: Up to 23 months

  2. Monotherapy (Modules 1 and 2) and Combination Therapy (Module 3): Disease Control Rate (DCR)

    The preliminary efficacy of RXC004 as a monotherapy and as a combination therapy was assessed. DCR was defined as the percentage of patients with a best overall response of either CR, PR or stable disease (SD) for at least 6 weeks.

    Measured: Up to 23 months

  3. Monotherapy (Modules 1 and 2) and Combination Therapy (Module 3): PFS

    The preliminary efficacy of RXC004 as a monotherapy and as a combination therapy was assessed. PFS was defined as the time from first dose of study treatment until the date of disease progression or death (by any cause in the absence of progression) regardless whether the patient withdrew from the assigned study treatment or received another anticancer prior to progression.

    Measured: Up to 23 months

  4. Monotherapy (Modules 1 and 2) and Combination Therapy (Module 3): Best Percentage Change in Tumor Size

    The preliminary efficacy of RXC004 as a monotherapy and as a combination therapy was assessed. The best percentage change in tumour size was determined at a patient level. For each patient, it represents the largest decrease (or smallest increase) in tumour size. Percentage change in tumour size was derived at each visit by the percentage change from baseline in the sum of diameters of all target lesions.

    Measured: Up to 23 months

  5. Monotherapy (Modules 1 and 2) and Combination Therapy (Module 3): Overall Survival (OS)

    The preliminary efficacy of RXC004 as a monotherapy and as a combination therapy was assessed. OS was defined as the time from first day of study treatment until death due to any cause.

    Measured: Up to 23 months

  6. Maximum Observed Plasma Concentration (Cmax)

    The pharmacokinetics (PK) of RXC004 as a monotherapy and as a combination therapy was assessed.

    Measured: At Cycle 0 Day 1 and Cycle 1 Day 15 (Each cycle was 21 days in length)

  7. Time to Cmax (Tmax)

    The PK (tmax) of RXC004 as a monotherapy and as a combination therapy was assessed.

    Measured: At Cycle 0 Day 1 and Cycle 1 Day 15 (Each cycle was 21 days in length)

  8. Minimum Observed Concentration Across the Dosing Interval (Cmin)

    The PK (Cmin) of RXC004 as a monotherapy and as a combination therapy was assessed.

    Measured: At Cycle 1 Day 15 (The cycle was 21 days in length) (Up to 23 months)

  9. Terminal Rate Constant (λz)

    The PK (λz) of RXC004 as a monotherapy and as a combination therapy was assessed.

    Measured: At Cycle 0 Day 1 (The cycle was 21 days in length)

  10. Terminal Half-life (t½)

    The PK (t½) of RXC004 as a monotherapy and as a combination therapy was assessed.

    Measured: At Cycle 0 Day 1(The cycle was 21 days in length)

  11. Area Under the Plasma Concentration-time Curve From Zero to Infinity (AUC0-∞)

    The PK (AUC0-∞) of RXC004 as a monotherapy and as a combination therapy was assessed.

    Measured: At Cycle 0 Day 1 (The cycle was 21 days in length)

  12. Total Plasma Clearance After Oral Administration (CL/F)

    The PK(CL/F) of RXC004 as a monotherapy and as a combination therapy was assessed.

    Measured: At Cycle 0 Day 1 (The cycle was 21 days in length)

  13. Apparent Volume of Distribution After Oral Administration (Vz/F)

    The PK (Vz/F) of RXC004 as a monotherapy and as a combination therapy was assessed.

    Measured: At Cycle 0 Day 1 (The cycle was 21 days in length)

  14. Number of Patients With Adverse Events (AEs)

    The safety, and tolerability profile of RXC004 as a monotherapy and as a combination therapy was assessed. The grading scales found in the revised National Cancer Institute CTCAE latest version was utilized for all events with an assigned CTCAE grading. Grade refers to the severity of the AE. The CTCAE displays Grades 1 through 5 with unique clinical descriptions of severity for each AE based on this general guideline: Grade 1 Mild; asymptomatic or mild symptoms; clinical or diagnostic observations only; intervention not indicated. Grade 2 Moderate; minimal, local or noninvasive intervention indicated; limiting age-appropriate instrumental ADL. Grade 3 Severe or medically significant but not immediately life-threatening; hospitalization or prolongation of hospitalization indicated; disabling; limiting self-care ADL; Grade 4: Life-threatening, urgent intervention required; Grade 5: Death related to AE.

    Measured: From time of signature of main study informed consent form throughout the treatment period and until the 30 days after last dose of RXC004 (Up to 23 months)

Timeline

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

  1. First posted1 Jun 2021
  2. Study start10 Dec 2021
  3. Primary completion30 Nov 2023
  4. Study completion30 Nov 2023

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 2
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
45 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04907851
Sponsor's protocol ID
RXC004/0003
Other IDs
MK-3475-E86, KEYNOTE-E86, 2020-005804-20
Acronym
KEYNOTE-E86
Status last verified
Feb 2025
First submitted
25 May 2021
Last updated
17 Mar 2025
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing RXC004, Denosumab and pembrolizumab in people with Advanced Solid Tumours, run by Redx Pharma Ltd at 13 sites in 2 countries.

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

Who may be eligible to take part?

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: finished, as of the sponsor's last update on 17 Mar 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 13 sites in United Kingdom, Australia. 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 phase mean?

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?

Yes. Results are posted in the registry (first posted 17 Mar 2025). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

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

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Monotherapy (Modules 1 and 2): Progression Free Survival Rate at 6 Months (time frame: At 6 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 17 Mar 2025.

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