Study of RSO-021 in Patients With Malignant Pleural Effusion Due to Advanced/Metastatic Solid Tumors Including Mesothelioma
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ClinicalTrials.gov Identifier: NCT05278975 |
Recruitment Status :
Recruiting
First Posted : March 15, 2022
Last Update Posted : January 26, 2024
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Condition or disease | Intervention/treatment | Phase |
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Malignant Pleural Effusion Malignant Pleural Mesothelioma Mesothelioma Mesotheliomas Pleural Mesothelioma; Lung Pleural Effusion, Malignant | Drug: RSO-021 | Phase 1 Phase 2 |
This is a Phase 1/2, open-label, multi-center study whose primary Phase 1 stage objective is to determine the maximum tolerated dose (MTD) or recommended phase 2 dose (RP2D) of RSO-021 (thiostrepton), a naturally-occurring, sulfur-rich, cyclic oligopeptide antibiotic of the thiopeptide class, in patients with MPE from any solid tumor, including mesothelioma.
In the Phase 2 stage, once the RP2D has been identified, the antitumor activity of RSO-021 will be evaluated in four recruitment arms; (1) in patients with MPE (non-mesothelioma), (2) in patients with MPE (non-mesothelioma) in combination with paclitaxel, (3) in patients with MPE from mesothelioma after first-line SoC, and (4) in patients with MPE from mesothelioma who have a 'window of opportunity' for treatment prior to first-line systemic therapy.
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 186 participants |
Allocation: | Non-Randomized |
Intervention Model: | Sequential Assignment |
Masking: | None (Open Label) |
Primary Purpose: | Treatment |
Official Title: | A Translational Phase 1/2 Dose-Escalation and Expansion Study to Determine Safety, Tolerability, and Recommended Phase 2 Dose of RSO-021 in Patients With Malignant Pleural Effusion Due to Advanced/Metastatic Solid Tumors Including Mesothelioma |
Actual Study Start Date : | March 31, 2022 |
Estimated Primary Completion Date : | April 1, 2025 |
Estimated Study Completion Date : | April 1, 2025 |
Arm | Intervention/treatment |
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Experimental: Phase 1 - Dose Escalation
RSO-021 administered in increasing doses as a solution for pleural infusion through an indwelling IP catheter, administered as a single dose on Day 1 of each week of a 21-day treatment cycle.
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Drug: RSO-021
A naturally-occurring, sulfur-rich, cyclic oligopeptide antibiotic of the thiopeptide class.
Other Name: Thiostrepton |
Experimental: Ph2 - Dose Expansion - MPE from non-mesothelioma solid tumors
RSO-021 administered at the MTD/RP2D as a solution for pleural infusion through an indwelling IP catheter, administered as a single dose on Day 1 of each week of a 21-day treatment cycle in patients with MPE from non-mesothelioma solid tumors.
|
Drug: RSO-021
A naturally-occurring, sulfur-rich, cyclic oligopeptide antibiotic of the thiopeptide class.
Other Name: Thiostrepton |
Experimental: Ph2 - Dose Expansion - MPE from mesothelioma
RSO-021 administered at the MTD/RP2D as a solution for pleural infusion through an indwelling IP catheter, administered as a single dose on Day 1 of each week of a 21-day treatment cycle in patients with MPE from mesothelioma.
|
Drug: RSO-021
A naturally-occurring, sulfur-rich, cyclic oligopeptide antibiotic of the thiopeptide class.
Other Name: Thiostrepton |
Experimental: P2 - Dose Expansion - mesothelioma -First line treatment prior to Ipi/Nivo
RSO-021 administered at the MTD/RP2D as a solution for pleural infusion through an indwelling IP catheter, administered as a single dose on Day 1 of each week of a 21-day treatment cycle in patients with mesothelioma. This local treatment with RSO-021 is prior to systemic treatment of Ipi/Nivo.
|
Drug: RSO-021
A naturally-occurring, sulfur-rich, cyclic oligopeptide antibiotic of the thiopeptide class.
Other Name: Thiostrepton |
Experimental: Ph2 - Dose Expansion - MPE from non-mesothelioma solid tumors combination with Paclitaxel
RSO-021 administered at the MTD/RP2D as a solution for pleural infusion through an indwelling IP catheter, administered as a single dose on Day 1 of each week of a 21-day treatment cycle in patients with MPE from non-mesothelioma solid tumors. In combination with Paclitaxel. Paclitaxel will be administered as a systemic therapy per SoC and the approved labeling based on the tumor type being treated. Paclitaxel is commercially available in the UK
|
Drug: RSO-021
A naturally-occurring, sulfur-rich, cyclic oligopeptide antibiotic of the thiopeptide class.
Other Name: Thiostrepton |
- Dose-limiting Toxicity [ Time Frame: First 21 days of treatment. ]The incidence of DLTs during the DLT assessment period.
- Frequency and Severity of Adverse Events (AE) [ Time Frame: Screening to 90 days from last dose. ]The incidences and percentages of patients experiencing AEs summarized by NCI CTCAE version 5.0 grade and by causality.
- Dose Finding [ Time Frame: Screening to 90 days from last dose. ]Determination of the MTD and/or the RP2D.
- Pharmacokinetics of RSO-021 [ Time Frame: Day 1 of dosing through 21 days post last dose. ]Maximum Plasma Concentration (Cmax)
- Pharmacokinetics of RSO-021 [ Time Frame: Day 1 of dosing through 21 days post last dose. ]Area Under the Curve (AUC)
- Objective Response Rate (ORR) [ Time Frame: Day 1 of dosing through day 90 after the last dose. ]ORR according to RECIST v1.1.
- Disease Control Rate (DCR) [ Time Frame: Day 1 of dosing through day 90 after the last dose. ]The percentage of subjects with a complete response, partial response, or stable disease for at least 2 consecutive tumor assessments.
- Progression Free Survival (PFS) [ Time Frame: Day 1 of dosing through day 90 after the last dose. ]Time from the date of initiation of study therapy to the date measurement criteria are first met for PD or death from any cause, whichever occurs first.
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.
Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Male or female ≥ 18 years old.
- ECOG performance status 0-1.
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Histological diagnosis of solid tumor/mesothelioma with MPE.
Expansion Cohort 2:
- only patients with breast cancer, ovarian cancer or non-small cell lung cancer.
- patients for whom paclitaxel is a recommended SoC therapy.
- no contraindications to paclitaxel.
- Patients with a disease burden that is predominantly pleural, and a pleural space that is accessible.
Expansion Cohorts 1 and 2: MPE (non-mesothelioma): patients must have received at least 1 prior standard of care treatment regimen for advanced, unresectable malignancy, with documented progression.
Expansion Cohort 3:
MPE mesothelioma: patients must have received at least 1 prior standard-of-care treatment regimen for advanced, unresectable malignancy, with documented progression and there is no approved life extending alternative available.
Expansion Cohort 4: MPE mesothelioma 'window of opportunity': patients should be treatment naïve, have refused or not be immediately requiring of systemic therapy and should be patients for whom drainage is planned immediately while further treatment options are arranged. It must be documented for each patient that protocol participation will not affect their subsequent ability to access standard systemic first line therapy due to RSO-021 being a local therapy.
6. Resolution of all acute reversible toxic effects of prior therapy or surgical procedure to Grade ≤1 (except alopecia).
7. For dose escalation: Archival paraffin block, ideally from the patient's most recent biopsy, should be provided prior to the first dose of study therapy, if sufficient tissue is available.
For dose expansion cohorts: fresh tumor biopsy must be obtained.
- Patients enrolled in the mesothelioma expansion phase will be requested to undergo a tumor biopsy during the screening period and after the third dose.
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Patients enrolled in the non-mesothelioma expansion phase will be requested to undergo a tumor biopsy during the screening period and after the third dose only if medically feasible.
8. Patients must have adequate organ function.
Exclusion Criteria:
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Last dose of prior anti-cancer therapies:
- Systemic anti-cancer therapy within 3 weeks or 5 half-lives prior to study entry, whichever is shorter.
- Thoracic radiation therapy or significant surgery within 3 weeks prior to study entry. Localized palliative radiotherapy for pain control in non-target lesions is allowed during the screening period.
- Received an investigational product or been treated with an investigational device within 30 days prior to first drug administration or plans to participate in any other clinical trial while on this study.
- Previous or concurrent malignancy that would prevent evaluation of the primary endpoint (e.g. R/R hematological malignancy).
- Patients whose extent of tumor or loculations would render intrapleural administration incomplete and/or ineffective.
- Known hypersensitivity to the active ingredient or any excipient contained in the drug formulation.
- History or clinical evidence of any surgical or medical condition which the investigator and/or medical monitor judges as likely to interfere with the results of the study or pose an additional risk in participating, e.g., rapidly progressive or uncontrolled disease involving a major organ system-vascular, cardiac, pulmonary, gastrointestinal, gynecologic, hematologic, neurologic, neoplastic, renal, endocrine, or an immunodeficiency, or clinically significant active psychiatric or abuse disorders.
- Active infection with human immunodeficiency virus (HIV) and CD4+ T-cell count < 350/μL. Patients not on established anti-retroviral therapy for at least four weeks prior to first dose of study drug and having a detectable HIV viral load. Testing is not required for eligibility.
- Active infection with hepatitis B (surface antigen); or infection with hepatitis C in absence of sustained virologic response. Testing is not required for eligibility.
- Pregnant or breast-feeding patients.
- Patients with symptomatic or unstable CNS primary tumor or metastases and/or carcinomatous meningitis. Patients with documented treated CNS metastases stable off steroids may be enrolled at the discretion of the investigator.
- Therapeutic oral anticoagulation for a thromboembolic event (prophylactic anticoagulation is allowed as long as patient can undergo catheter placement and biopsy). LMWH is allowed on condition that it is medically acceptable to interrupt LMWH therapy for all study procedures.
- Use of systemic corticosteroids to treat inflammatory or autoimmune symptoms within 15 days or other immunosuppressive drugs within 3 weeks prior to start of the study. Inhaled and topical corticosteroids are permitted. Up to 10 mg/day prednisone or equivalent is permitted.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT05278975
Contact: George Naumov, PhD | (617) 835-5633 | MITOPE@rsoncology.com |
United Kingdom | |
South Mead North Bristol Hopsital | Recruiting |
Bristol, United Kingdom, BS105NB | |
Contact: Louise Standon louise.stadon@nbt.nhs.uk | |
Principal Investigator: Nick Maskell, MD | |
NHS Greater Glasgow & Clyde | Recruiting |
Glasgow, United Kingdom | |
Contact: Stephanie Hughes stephanie.hughes@ggc.scot.nhs.uk | |
Principal Investigator: Kevin Blyth, MD | |
Leeds Teaching Hospital | Recruiting |
Leeds, United Kingdom, LS970F | |
Contact leedsth-tr.earlyphaseadmin@nhs.net | |
Principal Investigator: Kevin Franks, MD | |
Facility: HOPE Clinical Trials Facility, Leicester Royal Infirmary | Recruiting |
Leicester, United Kingdom, LE1 5WW | |
Contact: Molly Scotland molly.scotland@uhl-tr.nhs.uk | |
Principal Investigator: Dean Fennell, MD | |
Barts Health NHS Cancer Institute | Recruiting |
London, United Kingdom, EC1A7BE | |
Contact: Maria Lapuente m.lapuente@nhs.net | |
Principal Investigator: Peter Szlosarek, MD | |
Guys and St Thomas NHS Foundation Trust | Recruiting |
London, United Kingdom, SE19RT | |
Contact: George Borley earlyphaseresearchteam@gstt.nhs.uk | |
Principal Investigator: James Spicer, MD | |
The Royal Marsden | Recruiting |
London, United Kingdom, SW3 6JJ | |
Contact: Bianca Peet Bianca.Peet@rmh.nhs.uk | |
Principal Investigator: Sanjay Popat, MD | |
The Christie NHS | Recruiting |
Manchester, United Kingdom, M204BX | |
Contact: Amy Henshaw amy.henshaw@nhs.net | |
Principal Investigator: Fiona Thistlethwaite, MD | |
Northumbria NorthTyne Side General Hospital | Recruiting |
North Shields, United Kingdom, NE29 8NH | |
Contact: Jessica Reynolds jessica.reynolds@northumbria-healthcare.nhs.uk | |
Principal Investigator: Avinash Aujayeb, MD | |
Oxford University Hospitals NHS Foundation | Recruiting |
Oxford, United Kingdom, OX42PG | |
Contact: David Mukkath trialadministrator4@oncology.ox.ac.uk | |
Principal Investigator: Simon Lord, MD |
Principal Investigator: | James Spicer, MD | Guys Hospital |
Responsible Party: | RS Oncology LLC |
ClinicalTrials.gov Identifier: | NCT05278975 |
Other Study ID Numbers: |
RS-TS-101-01 |
First Posted: | March 15, 2022 Key Record Dates |
Last Update Posted: | January 26, 2024 |
Last Verified: | January 2024 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | No |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
Product Manufactured in and Exported from the U.S.: | No |
Neoplasms, Glandular and Epithelial Neoplasms by Histologic Type Neoplasms Neoplasms, Mesothelial Lung Neoplasms Respiratory Tract Neoplasms Thoracic Neoplasms Neoplasms by Site Pleural Neoplasms Mesothelioma |
Mesothelioma, Malignant Pleural Effusion, Malignant Pleural Effusion Adenoma Lung Diseases Respiratory Tract Diseases Pleural Diseases Thiostrepton Anti-Bacterial Agents Anti-Infective Agents |