A Phase I/II Study of Peposertib (M3814) and Avelumab in Combination With Hypofractionated Radiation in Patients With Advanced/Metastatic Solid Tumors and Hepatobiliary Malignancies

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Active drug More information Started >3 years ago More information High burden on patient More information

Trial Details

Sponsor: National Cancer Institute (NCI) (federal)

Phase: 1/2

Start date: April 7, 2020

Planned enrollment: 103

Trial ID: NCT04068194
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More trial details at ClinicalTrials.gov More info

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chevron Show for: Peposertib (M3814, MSC2490484A, Nedisertib)

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Goal: Define the safety, tolerability, and recommended phase 2 dose of the DNA-PK inhibitor peposertib combined with hypofractionated radiation and avelumab (phase I), and test whether adding peposertib to hypofractionated radiation plus avelumab improves efficacy versus radiation plus avelumab alone in advanced/metastatic hepatobiliary cancers, using objective response rate in non-irradiated lesions (phase II).

Patients: Phase I enrolls adults with metastatic or unresectable advanced solid tumors that have progressed after, are not candidates for, or decline standard therapy, ECOG 0–2, with at least one lesion suitable for palliative hypofractionated RT and at least one separate RECIST-measurable, non-irradiated lesion. Phase II enrolls adults with metastatic or unresectable cholangiocarcinoma or gallbladder carcinoma after progression on gemcitabine/cisplatin with durvalumab or pembrolizumab (TOPAZ-1 or KEYNOTE-966), meeting standard hematologic, renal, hepatic, and coagulation criteria, and willing to undergo mandated biopsies and biospecimen collection. Key exclusions include active autoimmune disease requiring significant immunosuppression, untreated/uncontrolled CNS disease, significant drug–drug interactions with CYP3A4/2C19 modulators or PPIs, recent live vaccination, and uncontrolled intercurrent illness or infection.

Design: Phase I dose-escalation of peposertib with fixed hypofractionated RT and avelumab to establish RP2D and characterize PK. Phase II randomized, active-controlled, parallel-group study in advanced/metastatic hepatobiliary tumors comparing hypofractionated RT plus avelumab (control) versus the same regimen with the addition of peposertib. Allocation is randomized; treatment continues in 28-day cycles until progression or unacceptable toxicity, with structured long-term follow-up.

Treatments: All arms incorporate hypofractionated radiation therapy delivered as 8 daily fractions between days −17 and −7 to one or two palliative targets, with systemic therapy starting day 1 of each 28‑day cycle. Avelumab is administered IV over 60 minutes on days 1 and 15. The experimental regimen adds oral peposertib twice daily on days 1–28 each cycle. Peposertib (M3814, nedisertib) is an oral inhibitor of DNA-dependent protein kinase (DNA-PKcs/PRKDC), a key mediator of non-homologous end-joining repair of DNA double-strand breaks. By blocking DNA-PK autophosphorylation and DSB repair, peposertib radiosensitizes tumor cells and can potentiate DSB-inducing therapies; pharmacodynamic effects include increased γH2AX foci. Early clinical studies show limited single-agent activity with disease stabilization and have defined tolerable combination doses with avelumab and with radiotherapy; toxicity can reflect radiosensitization (e.g., dermatitis, mucositis), necessitating careful dose selection. Avelumab is an anti–PD-L1 monoclonal antibody used as standard immunotherapy in several tumors; here it is combined with RT, with or without peposertib, to test for systemic responses outside the irradiated field.

Outcomes: Primary endpoints: Phase I maximum tolerated dose and recommended phase 2 dose of peposertib with RT and avelumab based on dose-limiting toxicities within 28 days; Phase II objective response rate by RECIST 1.1 in non-irradiated lesions up to 12 months. Secondary endpoints include safety (CTCAE v5.0), disease control rate, duration of response, progression-free survival (overall and outside irradiated field), overall survival, and pharmacokinetics of peposertib and avelumab (including trough levels). Translational/exploratory endpoints assess baseline DNA damage repair defects (γH2AX/pNBS1/pKAP1 IFA), tumor mutation and neoantigen burden (WES, RNAseq), immune landscape changes (MIBI, CyTOF), and TCR clonality, correlating these biomarkers with response and toxicity.

Burden on patient: Burden is high. Patients undergo hypofractionated RT requiring daily visits for 8 fractions before systemic therapy, IV avelumab infusions on days 1 and 15 each 28‑day cycle, and continuous twice-daily oral peposertib in the experimental arms. The protocol mandates fresh tumor biopsies at baseline and on-treatment collections, plus extensive blood sampling for pharmacokinetics (including intensive post-infusion timepoints in phase I) and immune correlative studies. Serial CT imaging and frequent safety assessments are required. Restrictions on concomitant medications (notably PPIs and strong CYP3A4/2C19 modulators) may necessitate regimen changes. Travel and time commitments are substantial, particularly early in treatment due to RT and PK schedules.

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Sites (45)

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UCI Health - Chao Family Comprehensive Cancer Center and Ambulatory Care

Irvine, California, 92612, United States

[email protected] / 877-827-8839

Status: Recruiting

UC San Diego Moores Cancer Center

La Jolla, California, 92093, United States

[email protected] / 858-822-5354

Status: Recruiting

UC Irvine Health/Chao Family Comprehensive Cancer Center

Orange, California, 92868, United States

[email protected] / 877-827-8839

Status: Recruiting

University of California Davis Comprehensive Cancer Center

Sacramento, California, 95817, United States

No email / No phone

Status: SUSPENDED

UCHealth University of Colorado Hospital

Aurora, Colorado, 80045, United States

No email / 720-848-0650

Status: Recruiting

Smilow Cancer Hospital-Derby Care Center

Derby, Connecticut, 06418, United States

[email protected] / 203-785-5702

Status: Recruiting

Smilow Cancer Hospital Care Center-Fairfield

Fairfield, Connecticut, 06824, United States

[email protected] / 203-785-5702

Status: Recruiting

Smilow Cancer Hospital Care Center at Glastonbury

Glastonbury, Connecticut, 06033, United States

[email protected] / 203-785-5702

Status: Recruiting

Smilow Cancer Hospital Care Center at Greenwich

Greenwich, Connecticut, 06830, United States

[email protected] / 203-785-5702

Status: Recruiting

Smilow Cancer Hospital Care Center - Guilford

Guilford, Connecticut, 06437, United States

[email protected] / 203-785-5702

Status: Recruiting

Smilow Cancer Hospital Care Center at Saint Francis

Hartford, Connecticut, 06105, United States

[email protected] / 203-785-5702

Status: Recruiting

Smilow Cancer Center/Yale-New Haven Hospital

New Haven, Connecticut, 06510, United States

[email protected] / 203-785-5702

Status: Recruiting

Yale University

New Haven, Connecticut, 06520, United States

[email protected] / 203-785-5702

Status: Recruiting

Yale-New Haven Hospital North Haven Medical Center

North Haven, Connecticut, 06473, United States

[email protected] / 203-785-5702

Status: Recruiting

Smilow Cancer Hospital Care Center at Long Ridge

Stamford, Connecticut, 06902, United States

[email protected] / 203-785-5702

Status: Recruiting

Smilow Cancer Hospital-Torrington Care Center

Torrington, Connecticut, 06790, United States

[email protected] / 203-785-5702

Status: Recruiting

Smilow Cancer Hospital Care Center-Trumbull

Trumbull, Connecticut, 06611, United States

[email protected] / 203-785-5702

Status: Recruiting

Smilow Cancer Hospital-Waterbury Care Center

Waterbury, Connecticut, 06708, United States

[email protected] / 203-785-5702

Status: Recruiting

Smilow Cancer Hospital Care Center - Waterford

Waterford, Connecticut, 06385, United States

[email protected] / 203-785-5702

Status: Recruiting

MedStar Georgetown University Hospital

Washington D.C., District of Columbia, 20007, United States

No email / 202-444-2223

Status: Recruiting

Sibley Memorial Hospital

Washington D.C., District of Columbia, 20016, United States

[email protected] / 202-243-2373

Status: Recruiting

UM Sylvester Comprehensive Cancer Center at Aventura

Aventura, Florida, 33180, United States

No email / 954-461-2180

Status: Recruiting

UM Sylvester Comprehensive Cancer Center at Coral Gables

Coral Gables, Florida, 33146, United States

No email / 305-243-2647

Status: Recruiting

UM Sylvester Comprehensive Cancer Center at Deerfield Beach

Deerfield Beach, Florida, 33442, United States

No email / 305-243-2647

Status: Recruiting

University of Miami Miller School of Medicine-Sylvester Cancer Center

Miami, Florida, 33136, United States

No email / 305-243-2647

Status: Recruiting

UM Sylvester Comprehensive Cancer Center at Kendall

Miami, Florida, 33176, United States

No email / 305-243-2647

Status: Recruiting

UM Sylvester Comprehensive Cancer Center at Plantation

Plantation, Florida, 33324, United States

No email / 305-243-2647

Status: Recruiting

Emory University Hospital Midtown

Atlanta, Georgia, 30308, United States

No email / 888-946-7447

Status: Recruiting

Emory University Hospital/Winship Cancer Institute

Atlanta, Georgia, 30322, United States

No email / 404-778-1868

Status: Recruiting

Emory Saint Joseph's Hospital

Atlanta, Georgia, 30342, United States

No email / 404-851-7115

Status: Recruiting

Northwestern University

Chicago, Illinois, 60611, United States

[email protected] / 312-695-1301

Status: Recruiting

Wayne State University/Karmanos Cancer Institute

Detroit, Michigan, 48201, United States

No email / No phone

Status: Active, not recruiting

Weisberg Cancer Treatment Center

Farmington Hills, Michigan, 48334, United States

No email / No phone

Status: Active, not recruiting

Rutgers Cancer Institute of New Jersey

New Brunswick, New Jersey, 08903, United States

No email / 732-235-7356

Status: Recruiting

Bellevue Hospital Center

New York, New York, 10016, United States

[email protected] / 646-754-4624

Status: Recruiting

Laura and Isaac Perlmutter Cancer Center at NYU Langone

New York, New York, 10016, United States

[email protected] / No phone

Status: Recruiting

NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center

New York, New York, 10032, United States

[email protected] / 212-342-5162

Status: Recruiting

NYP/Weill Cornell Medical Center

New York, New York, 10065, United States

No email / 212-746-1848

Status: Recruiting

University of Pittsburgh Cancer Institute (UPCI)

Pittsburgh, Pennsylvania, 15232, United States

No email / 412-647-8073

Status: Recruiting

Smilow Cancer Hospital Care Center - Westerly

Westerly, Rhode Island, 02891, United States

[email protected] / 203-785-5702

Status: Recruiting

Vanderbilt University/Ingram Cancer Center

Nashville, Tennessee, 37232, United States

No email / 800-811-8480

Status: Recruiting

Huntsman Cancer Institute/University of Utah

Salt Lake City, Utah, 84112, United States

[email protected] / 888-424-2100

Status: Recruiting

VCU Massey Comprehensive Cancer Center

Richmond, Virginia, 23298, United States

[email protected] / 804-628-6430

Status: Recruiting

University of Wisconsin Carbone Cancer Center - Eastpark Medical Center

Madison, Wisconsin, 53718, United States

[email protected] / 800-622-8922

Status: Recruiting

University of Wisconsin Carbone Cancer Center - University Hospital

Madison, Wisconsin, 53792, United States

[email protected] / 800-622-8922

Status: Recruiting

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