Brentuximab Vedotin (SGN-35) as Salvage Treatment for CD30-positive Germ Cell Tumors

Overview

The purpose of the study is to assess the activity of Brentuximab vedotin in refractory germ cell tumors.

Full Title of Study: “Brentuximab Vedotin (SGN-35) as Salvage Therapy for Males With Advanced and Platinum-resistant Germ-cell Tumors. An Open Label, Single Group, Phase 2 Trial.”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: N/A
    • Intervention Model: Single Group Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: August 2017

Detailed Description

Complete responses with third-line or later salvage chemotherapy (CT) for germ cell tumors (GCT) range 0% to 10% and are usually short-lived and nearly all patients (pts) progressing after multiple courses or high-dose CT will ultimately die from progressive disease.

Cluster of Differentiation antigen-30 (CD30) is expressed by untreated embryonal carcinoma (ECA) thus lending support to a rationale for a targeted approach. The investigators retrospectively re-assessed ECA to strongly retain CD30 staining in most cases (>70%), even after multiple courses or high-dose CT. Moreover, a negative prognostic value of CD30 expression by residuals after CT, particularly in the salvage setting, was set. Brentuximab vedotin is an antibody-drug conjugate consisting of the chimeric anti-CD30 antibody chemically conjugated to an antitubulin synthetic analog (MMAE).

Proof of activity will provide rationale for developing first-line chemo-immunotherapy or maintenance immunotherapy for selected high-risk pts. The primary objective of the study will be the activity of Brentuximab vedotin in refractory GCT. Secondary objectives will include safety and survival.

24 pts with biopsy-proven CD30 positive GCT will receive intravenous Brentuximab vedotin at the dose of 1.8 mg/Kg every 3 weeks until disease progression or onset of unacceptable toxicity. Further eligibility requirements will include failure of 2 or 3 platinum-based CT (prior high-dose CT is allowed). All pts will undergo measurement of serum tumor markers, a computed tomography and a positron emission tomography (PET) scan every weeks. An optimal Simon's 2-stage design will be applied. The primary endpoint is the objective response-rate (ORR). An ORR of 5% is not promising, while a 25% rate will be promising. In stage 1, 9 evaluable patients will be accrued. The type I and II error are both set at 10%.

Additional post-treatment tissue will be available for pts undergoing surgery in the treatment time-course. Tissue array blocks will be constructed from samples of all pts. Assessment will include mutational analysis of most-frequently mutated genes. Two serum aliquots will be collected at baseline and during/end of treatment to assess circulating CD30.

Interventions

  • Drug: Brentuximab Vedotin
    • Intravenous Brentuximab Vedotin at the dose of 1.8 mg/Kg every 3 weeks until disease progression or onset of unacceptable toxicity

Arms, Groups and Cohorts

  • Experimental: Brentuximab Vedotin
    • Intravenous Brentuximab Vedotin at the dose of 1.8 mg/Kg every 3 weeks until disease progression or onset of unacceptable toxicity

Clinical Trial Outcome Measures

Primary Measures

  • The number of objective responses (partial and complete responses) according to the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 integrated with response of serum tumor markers.
    • Time Frame: Six weeks after the first administration of the study drug.

Secondary Measures

  • Progression-Free Survival
    • Time Frame: 3 months after the initiation of study treatment
  • Overall Survival
    • Time Frame: Six months after the initiation of study treatment
  • Incidence of adverse events related to the study drug
    • Time Frame: Six weeks after the initiation of the study drug and every 6 weeks thereafter up to 16 weeks.

Participating in This Clinical Trial

Inclusion Criteria

  • Age of at least 18 years.
  • Confirmation of germ cell tumor histology based on pathologic review at the study site.
  • Presence of a CD30 positive embryonal carcinoma component.
  • Unequivocal progression of measurable disease.
  • A minimum of 2 and a maximum of 3 platinum-based chemotherapy lines for metastatic disease EXCEPT for primary mediastinal germ cell tumors where failure of first-line chemotherapy only is accepted.
  • Prior high dose chemotherapy with hematopoietic stem cell rescue is allowed.

Exclusion Criteria

  • Failure to meet any of the above inclusion criteria.
  • Patients with late-relapse (defined as relapse occurring after at least 2 years from the date of completion of the last chemotherapy regimen) whose disease is completely surgically resectable (and for whom initial surgical extirpation is recommended) are ineligible. Patients with unresectable late disease relapse are eligible.

Gender Eligibility: Male

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Fondazione Michelangelo
  • Collaborator
    • Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Alessandro M Gianni, MD, Study Chair, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
    • Roberto Salvioni, MD, Study Chair, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
    • Andrea Necchi, MD, Principal Investigator, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan

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