Study of PDR001 and/or MBG453 in Combination With Decitabine in Patients With AML or High Risk MDS

• ClinicalTrials.gov Identifier: NCT03066648
• Recruitment Status: Completed
• First Posted: February 28, 2017
• Last Update Posted: October 2, 2023
• Sponsor: Novartis Pharmaceuticals
• Information provided by (Responsible Party): Novartis ( Novartis Pharmaceuticals )

Study Description

Brief Summary:

To characterize the safety and tolerability of 1) MBG453 as a single agent or in combination with PDR001 or 2) PDR001 and/or MBG453 in combination with decitabine or azacitidine in AML and intermediate or high- risk MDS patients, and to identify recommended doses for future studies.

Condition or disease	Intervention/treatment	Phase
Leukemia; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Myelodysplastic Syndromes; Preleukemia; Bone Marrow Diseases; Hematologic Diseases; Chronic Myelomonocytic Leukemia	Drug: Decitabine; Drug: PDR001; Drug: MBG453; Drug: Azacitidine	Phase 1

Detailed Description:

This is a phase 1b, multi-arm, open-label study in patients with acute myeloid leukemia (AML) or intermediate or high risk myelodysplastic syndrome (MDS). Patients with myelodysplastic-myeloproliferative neoplasms (MDS/MPN), including chronic myelomonocytic leukemia (CMML) could also be enrolled.

The study was comprised of six arms as described below. Arms 1-3 enrolled patients with newly diagnosed AML who were planned for non-intensive chemotherapy, relapsed/refractory (R/R) AML, or intermediate or high-risk MDS.

• Arm 1: Evaluation of a fixed dose of the standard of care agent decitabine in combination with fixed dose PDR001.
• Arm 2: Evaluation of a fixed dose of the standard of care agent decitabine in combination with escalating dose MBG453.
• Arm 3: Evaluation of a fixed dose of the standard of care agent decitabine in combination with fixed dose PDR001 and escalating dose MBG453.

Arms 4-5 enrolled patients with R/R AML or intermediate or high-risk MDS who had failed hypomethylating agent therapy.

• Arm 4: Evaluation of an escalating dose of MBG453
• Arm 5: Evaluation of an escalating dose of MBG453 in combination with fixed dose PDR001 Arm 6 enrolled patients with newly diagnosed AML who were planned for non-intensive chemotherapy, or intermediate or high-risk MDS.
• Arm 6: Evaluation of a fixed dose of the standard of care agent azacitidine in combination with an escalating dose of MBG453.

Patients received the assigned treatment until disease progression, unacceptable toxicity, start of a new anti-neoplastic therapy, discontinuation at the discretion of the investigator or patient, lost to follow-up, death, or the study termination, whichever occurred first.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 241 participants
• Allocation: Non-Randomized
• Intervention Model: Parallel Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Phase 1b, Multi-arm, Open-label Study of PDR001 and/or MBG453 in Combination With Decitabine in Patients With Acute Myeloid Leukemia or High Risk Myelodysplastic Syndrome
• Actual Study Start Date: July 6, 2017
• Actual Primary Completion Date: September 8, 2023
• Actual Study Completion Date: September 8, 2023

Arms and Interventions

Arm	Intervention/treatment
Experimental: Decitabine and PDR001; Decitabine in combination with PDR001	Drug: Decitabine; Decitabine is a cytidine deoxynucleoside analogue that selectively inhibits DNA methyltransferases at low doses, resulting in gene promoter hypomethylation.; Other Name: 5-aza-2'-deoxycytidine; Drug: PDR001; PDR001 is a high-affinity, ligand-blocking, humanized IgG4 monoclonal antibody directed against PD-1 that blocks the binding of PD-L1 and PD-L2.; Other Name: spartalizumab
Experimental: Decitabine and MBG453; Decitabine in combination with MBG453	Drug: Decitabine; Decitabine is a cytidine deoxynucleoside analogue that selectively inhibits DNA methyltransferases at low doses, resulting in gene promoter hypomethylation.; Other Name: 5-aza-2'-deoxycytidine; Drug: MBG453; MBG453 is a high-affinity, humanized anti-TIM-3 IgG4 monoclonal antibody which blocks the binding of TIM-3 to phosphatidylserine (PtdSer).; Other Name: sabatolimab
Experimental: Decitabine, PDR001 and MBG453; Decitabine in combination with PDR001 and MBG453	Drug: Decitabine; Decitabine is a cytidine deoxynucleoside analogue that selectively inhibits DNA methyltransferases at low doses, resulting in gene promoter hypomethylation.; Other Name: 5-aza-2'-deoxycytidine; Drug: PDR001; PDR001 is a high-affinity, ligand-blocking, humanized IgG4 monoclonal antibody directed against PD-1 that blocks the binding of PD-L1 and PD-L2.; Other Name: spartalizumab; Drug: MBG453; MBG453 is a high-affinity, humanized anti-TIM-3 IgG4 monoclonal antibody which blocks the binding of TIM-3 to phosphatidylserine (PtdSer).; Other Name: sabatolimab
Experimental: MBG453; MBG453 alone	Drug: MBG453; MBG453 is a high-affinity, humanized anti-TIM-3 IgG4 monoclonal antibody which blocks the binding of TIM-3 to phosphatidylserine (PtdSer).; Other Name: sabatolimab
Experimental: MBG453 and PDR001; MBG453 in combination with PDR001	Drug: PDR001; PDR001 is a high-affinity, ligand-blocking, humanized IgG4 monoclonal antibody directed against PD-1 that blocks the binding of PD-L1 and PD-L2.; Other Name: spartalizumab; Drug: MBG453; MBG453 is a high-affinity, humanized anti-TIM-3 IgG4 monoclonal antibody which blocks the binding of TIM-3 to phosphatidylserine (PtdSer).; Other Name: sabatolimab
Experimental: Azacitidine and MBG453; Azacitidine in combination with MBG453	Drug: MBG453; MBG453 is a high-affinity, humanized anti-TIM-3 IgG4 monoclonal antibody which blocks the binding of TIM-3 to phosphatidylserine (PtdSer).; Other Name: sabatolimab; Drug: Azacitidine; Azacitidine (5-azacytidine) is a cytidine nucleoside analogue that selectively inhibits DNA methyltransferases at low doses, resulting in gene promoter hypomethylation; Other Name: 5-azacytidine

Outcome Measures

Primary Outcome Measures :

1. Safety of MBG453 single agent treatment or MBG453 in combination with PDR001 or PDR001 and/or MBG453 in combination with decitabine or azacitidine. [ Time Frame: 24 months ]
   Incidence and severity of AEs and SAEs
2. Incidence of Dose Limiting Toxicities (DLTs) [ Time Frame: 2 months ]
   The incidence of DLTs during the first two cycles of treatment with MBG453 in combination with PDR001 or PDR001 and/or MBG453 in combination with decitabine.
3. Incidence of Dose Limiting Toxicities (DLTs) [ Time Frame: 1 month ]
   The incidence of DLTs during the first cycle of MBG453 single agent treatment or during the first two cycles of treatment with MBG453 in combination with PDR001 or PDR001 and/or MBG453 in combination with decitabine.
4. Tolerability of MBG453 single agent treatment or MBG453 in combination with PDR001 or PDR001 and/or MBG453 in combination with decitabine or azacitidine. [ Time Frame: 24 months ]
   Incidence and severity of AEs and SAEs

Secondary Outcome Measures :

1. AUC of PDR001, MBG453, decitabine and azacitidine. [ Time Frame: 24 months ]
   AUC
2. Cmax of PDR001, MBG453, decitabine and azacitidine [ Time Frame: 24 months ]
   Cmax
3. Tmax of PDR001, MBG453, decitabine and azacitidine [ Time Frame: 24 months ]
   Tmax
4. Half-life of PDR001, MBG453, decitabine and azacitidine [ Time Frame: 24 months ]
   Half-life
5. Overall Response Rate (ORR) [ Time Frame: 24 months ]
   Determine ORR in each arm of the study
6. Best Overall Response (BOR) [ Time Frame: 24 months ]
   Determine BOR in each arm of the study
7. Progression Free Survival (PFS) [ Time Frame: 24 months ]
   Determine PFS in each arm of the study
8. Time to Progression (TTP) [ Time Frame: 24 months ]
   Determine TTP in each arm of the study
9. Duration of Response (DOR) [ Time Frame: 24 months ]
   Determine DOR in each arm of the study
10. Number of participants with anti-PDR001 and anti-MBG453 antibodies [ Time Frame: 24 months ]
    Presence of anti-PDR001 and anti-MBG453 antibodies.

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

1. Written informed consent must be obtained prior to any screening procedures

2. Male or female patients ≥ 18 years of age who present with one of the following:

   Arms 1-3:

   • Relapsed/refractory AML following ≥1 prior therapies who have relapsed or exhibited refractory disease (primary failure) and are deemed by the investigator not to be candidates for standard therapy, including re-induction with cytarabine or other established chemotherapy regimens for patients with AML (patients who are suitable for standard re-induction chemotherapy or hematopoietic stem cell transplantation and willing to receive it are excluded)
   • Newly diagnosed AML patients who are suitable for treatment with decitabine (patients who are suitable for standard induction chemotherapy or hematopoietic stem cell transplantation and willing to receive it are excluded)
   • Intermediate or high risk MDS or MDS/MPN including CMML (patients who are suitable for standard re-induction chemotherapy or hematopoietic stem cell transplantation and willing to receive it are excluded)

   Arms 4-5:

   • Refractory / relapsed AML following ≥1 prior therapies (Arms 4a & 5a)
   • Intermediate or high risk MDS or MDS/MPN including CMML who have failed hypomethylating agent therapy (Arms 4b & 5b) (Note: hypomethylating agent failure is defined as progressive disease on hypomethylating agent therapy or lack of clinically meaningful response as deemed by investigator after at least 4 cycles of hypomethylating agent therapy.)

   Arm 6:

   • Newly diagnosed AML patients who are suitable for treatment with azacitidine (patients who are suitable for standard induction chemotherapy or hematopoietic stem cell transplantation and willing to receive it are excluded) (Arm 6a)
   • Intermediate or high-risk MDS or MDS/MPN including CMML (patients who are suitable for standard induction chemotherapy or hematopoietic stem cell transplantation and willing to receive it are excluded) (Arm 6b)
3. Patient has an Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2
4. Patient must be a candidate for serial bone marrow aspirate and/or biopsy according to the institutions guidelines and be willing to undergo a bone marrow aspirate and/biopsy at screening, during and at the end of therapy on this study. Exceptions may be considered after documented discussion with Novartis.
5. Arms 1-3: Patients must be fit for standard treatment with decitabine as determined by the investigator and as per local decitabine package insert.
6. Arm 6: Patients must be fit for standard treatment with azacitidine as determined by the investigator and as per the local azacitidine package insert.

Exclusion Criteria:

1. Arms 1-3 or Arm 6: Patients who have received prior hypomethylating agent treatment for AML or MDS.
2. Patients with active, known or suspected autoimmune disease. Patients with vitiligo, type I diabetes, residual hypothyroidism only requiring hormone replacement, psoriasis not requiring systemic treatment or conditions not expected to recur should not be excluded.
3. History of, or current drug-induced interstitial lung disease or pneumonitis grade ≥ 2.
4. Patients who discontinued prior PD-1 or PD-L1 directed therapy due to a treatment related toxicity should not be included in the PDR001 containing arms of the study. Patients previously exposed to anti-PD-1/PD-L1 treatment who are adequately treated for skin rash or with replacement therapy for endocrinopathies should not be excluded.
5. Systemic antineoplastic therapy (including cytotoxic chemotherapy, alphainterferon, kinase inhibitors or other targeted small molecules, and toxinimmunoconjugates) or any experimental therapy within 14 days or 5 half-lives, whichever is shorter, before the first dose of study treatment.
6. Systemic chronic corticosteroid therapy (>10 mg/day prednisone or equivalent) or any immunosuppressive therapy within 7 days of first dose of study treatment. Topical, inhaled, nasal and ophthalmic steroids are allowed.

Other protocol-defined inclusion/exclusion criteria may apply.

Contacts and Locations

Locations

United States, Massachusetts

Massachusetts General Hospital

Boston, Massachusetts, United States, 02114

United States, Oregon

Oregon Health Sciences University Main Center

Portland, Oregon, United States, 97239

United States, Texas

MD Anderson Cancer Center

Houston, Texas, United States, 77030

Australia, Victoria

Novartis Investigative Site

Melbourne, Victoria, Australia, 3004

Finland

Novartis Investigative Site

Helsinki, Finland, FIN 00290

France

Novartis Investigative Site

Marseille, France, 13273

Germany

Novartis Investigative Site

Dresden, Germany, 01307

Novartis Investigative Site

Jena, Germany, 07740

Netherlands

Novartis Investigative Site

Amsterdam, Netherlands, 1081 HV

Spain

Novartis Investigative Site

Barcelona, Catalunya, Spain, 08036

United Kingdom

Novartis Investigative Site

Cardiff, United Kingdom, CF4 4XN

Sponsors and Collaborators

Novartis Pharmaceuticals

Investigators

• Study Director: Novartis Pharmaceuticals; Novartis Pharmaceuticals

More Information

• Responsible Party: Novartis Pharmaceuticals
• ClinicalTrials.gov Identifier: NCT03066648
• Other Study ID Numbers: CPDR001X2105; 2016-005060-33 ( EudraCT Number )
• First Posted: February 28, 2017
• Last Update Posted: October 2, 2023
• Last Verified: September 2023

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

• Studies a U.S. FDA-regulated Drug Product: Yes
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Novartis ( Novartis Pharmaceuticals ):

Acute Myeloid Leukemia; Myelodysplastic syndromes; Chronic Myelomonocytic Leukemia

Additional relevant MeSH terms:

Leukemia; Preleukemia; Leukemia, Myelomonocytic, Chronic; Leukemia, Myelomonocytic, Juvenile; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Myelodysplastic Syndromes; Hematologic Diseases; Bone Marrow Diseases; Syndrome; Disease; Pathologic Processes; Neoplasms by Histologic Type; Neoplasms; Precancerous Conditions; Myelodysplastic-Myeloproliferative Diseases; Chronic Disease; Disease Attributes; Azacitidine; Decitabine; Spartalizumab; Antimetabolites, Antineoplastic; Antimetabolites; Molecular Mechanisms of Pharmacological Action; Antineoplastic Agents; Enzyme Inhibitors; Immune Checkpoint Inhibitors; Antineoplastic Agents, Immunological