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This study is being conducted to evaluate the overall safety and effectiveness of an investigational drug, GC1008, in patients with mesothelioma. An investigational drug is one that has not been approved by the FDA. Approximately 40 people will be enrolled on this study at the University of Pennsylvania (Main Institution/Coordinating Site) and the University of Chicago (Participating Institution). We expect about 20 subjects to be enrolled at each institution.
Primary: - To assess progression-free survival rate at three months.
Secondary: - To determine the toxicity and safety of systemic infusion of anti-TGF beta antibody at three-week dosing intervals. - To assess time to progression and overall survival - to assess response rate using Modified RECIST Criteria for Mesothelioma Additional Objectives: - To assess efficacy using serial measurements of serum [and intrapleural, if indwelling catheter in place] biomarkers, including serum-mesothelin related peptide (SMRP/Mesomark®) and osteopontin. - To assess systemic [and intrapleural if indwelling catheter in place] humoral anti-tumor immune responses after repeated anti-TGF beta antibody instillation. - To assess systemic [and intrapleural, if indwelling catheter in place] TGF beta, and other cytokine levels after repeated anti-TGF beta antibody instillation. - To assess biologic response measurements of TGF beta blockade from serum tests and from pleural fluid or biopsy tissue if this is available.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Investigational drug infusion-for safety and effectiveness | Experimental | Phase II, Single-Arm, Multi-Site study. All subjects will receive the investigational agent, GC1008 in 3 week cycles of treatment |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| GC1008 | Drug | GC1008 is a human IgG4 kappa monoclonal antibody capable of neutralizing all mammalian isoforms of TGFbeta (i.e., beta1, beta 2 and beta 3). GC1008 is a high affinity antibody with dissociation constants (Kds) of 1.8 nM, 2.8 nM and 1.4 nM for TGF1,2,and 3, respectively. |
| Measure | Description | Time Frame |
|---|---|---|
| 3-month Progression Free Survival Rate | The fraction of subjects surviving 3 months without disease progression. | 3 months |
| Measure | Description | Time Frame |
|---|---|---|
| Toxicity and Safety of Systemic Infusion of Anti-TGF Antibody | The toxicity and safety of systemic infusion of anti-TGF antibody at three-week dosing intervals. Number subjects with Grade 2 and Grade 3/4 treatment related toxicities. | 18 months |
| Measure | Description | Time Frame |
|---|---|---|
| Time to Progression and Overall Survival | Assessment of time to disease progression and overall survival | 18 months |
| Response Rate Using Modified RECIST Criteria for Mesothelioma | Response and progression will be evaluated in this study using the international criteria proposed by the revised Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1). Changes in the largest diameter (unidimensional measurement) of the tumor lesions and the shortest diameter in the case of malignant lymph nodes are used in RECIST. The response assessment is based on the presence, absence, or unequivocal progression of the lesions. |
Inclusion Criteria:
Patients must have had at least one, but no more than two prior systemic therapies, at least one of which contained pemetrexed.
Exclusion Criteria:
Patients with a remote history of asthma or active mild asthma may participate.
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| Name | Affiliation | Role |
|---|---|---|
| James Stevenson, MD | Abramson Cancer Center at Penn Medicine | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Abramson Cancer Center of the University of Pennsylvania | Philadelphia | Pennsylvania | 19104 | United States |
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| ID | Title | Description |
|---|---|---|
| FG000 | Investigational Drug infusion-for Safety and Effectiveness | Phase II, Single-Arm, Multi-Site study. All subjects will receive the investigational agent, GC1008 in 3 week cycles of treatment GC1008: GC1008 is a human IgG4 kappa monoclonal antibody capable of neutralizing all mammalian isoforms of TGFbeta (i.e., beta1, beta 2 and beta 3). GC1008 is a high affinity antibody with dissociation constants (Kds) of 1.8 nM, 2.8 nM and 1.4 nM for TGF1,2,and 3, respectively. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Investigational Drug infusion-for Safety and Effectiveness | Phase II, Single-Arm, Multi-Site study. All subjects will receive the investigational agent, GC1008 in 3 week cycles of treatment GC1008: GC1008 is a human IgG4 kappa monoclonal antibody capable of neutralizing all mammalian isoforms of TGFbeta (i.e., beta1, beta 2 and beta 3). GC1008 is a high affinity antibody with dissociation constants (Kds) of 1.8 nM, 2.8 nM and 1.4 nM for TGF1,2,and 3, respectively. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | 3-month Progression Free Survival Rate | The fraction of subjects surviving 3 months without disease progression. | Outcome analysis presented in manuscript of results of trial based on 13 participants. | Posted | Count of Participants | Participants | 3 months |
|
Adverse event data was collected from time of first administration of study product until 30 days of the last administration of study product, approximately 1 year and 5 months.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Investigational Drug infusion-for Safety and Effectiveness | Phase II, Single-Arm, Multi-Site study. All subjects will receive the investigational agent, GC1008 in 3 week cycles of treatment. GC1008: GC1008 is a human IgG4 kappa monoclonal antibody capable of neutralizing all mammalian isoforms of TGFbeta (i.e., beta1, beta 2 and beta 3). GC1008 is a high affinity antibody with dissociation constants (Kds) of 1.8 nM, 2.8 nM and 1.4 nM for TGF1,2,and 3, respectively. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Nausea | Gastrointestinal disorders | NCI CTCAE v.4.0 | Systematic Assessment |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Anorexia | Metabolism and nutrition disorders | NCI CTCAE v.4.0 | Systematic Assessment |
Limitations of the trial include small sample size and lack of post-tumor treatment samples.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| James Robinson | AbramsonCC | 215-662-8758 | jamesrobinson2@pennmedicine.upenn.edu |
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| ID | Term |
|---|---|
| D000086002 | Mesothelioma, Malignant |
| ID | Term |
|---|---|
| D008654 | Mesothelioma |
| D000236 | Adenoma |
| D009375 | Neoplasms, Glandular and Epithelial |
| D009370 | Neoplasms by Histologic Type |
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| ID | Term |
|---|---|
| C560928 | fresolimumab |
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|
|
| 18 months |
| Number of Participants With a Change of Serum Biomarkers After Therapy | Evaluation of changes after treatment therapy to a number of potential blood biomarkers of TGF-β effect (serum osteopontin, serum hyaluronan, serum MMP-1, serum MMP-7, serum IL-6, plasma CCL18, plasma VEGF, and plasma PAI-1). Animal models predict acute changes in TGF-β levels in blood associated with changes in serum biomarkers. | 18 months |
| Number of Participants With Systemic Humoral Anti-tumor Immune Response After Repeated Anti-TGFβ Antibody Instillation | Comparing antibody bands in pre-treatment versus post-treatment serum | 18 months |
| Assessment of Systemic TGFβ After Repeated Anti-TGFβ Antibody Installation | The number of participants with significant change in percentage of circulating CD4+ T regulatory cells, marked by expression of FOXP3 after treatment. TGFβ has been implicated in the formation of T regulatory cells, and the blockade of TGFβ in animal models can inhibit the formation of T regulatory cells. | 18 months |
| Biologic Response Measurements of TGFβ Blockade | Number of participants who demonstrated upregulation of NK cell receptors 3 weeks after treatment. There are data that show anti-TGFβ antibodies can upregulate NK cell receptors in patients with chronic viral infections. TGFβ blockade was measured in samples of serum tests and from pleural fluid or biopsy if available. | 3 weeks |
| Participants |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| Units | Counts |
|---|---|
| Participants |
|
|
| Secondary | Toxicity and Safety of Systemic Infusion of Anti-TGF Antibody | The toxicity and safety of systemic infusion of anti-TGF antibody at three-week dosing intervals. Number subjects with Grade 2 and Grade 3/4 treatment related toxicities. | Outcome analysis presented in manuscript of results of trial based on 13 participants. | Posted | Number | participants | 18 months |
|
|
|
| Other Pre-specified | Time to Progression and Overall Survival | Assessment of time to disease progression and overall survival | Outcome analysis presented in manuscript of results of trial based on 13 participants. | Posted | Median | 95% Confidence Interval | Months | 18 months |
|
|
|
| Other Pre-specified | Response Rate Using Modified RECIST Criteria for Mesothelioma | Response and progression will be evaluated in this study using the international criteria proposed by the revised Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1). Changes in the largest diameter (unidimensional measurement) of the tumor lesions and the shortest diameter in the case of malignant lymph nodes are used in RECIST. The response assessment is based on the presence, absence, or unequivocal progression of the lesions. | Outcome analysis presented in manuscript of results of trial based on 13 participants. | Posted | Count of Participants | Participants | 18 months |
|
|
|
| Other Pre-specified | Number of Participants With a Change of Serum Biomarkers After Therapy | Evaluation of changes after treatment therapy to a number of potential blood biomarkers of TGF-β effect (serum osteopontin, serum hyaluronan, serum MMP-1, serum MMP-7, serum IL-6, plasma CCL18, plasma VEGF, and plasma PAI-1). Animal models predict acute changes in TGF-β levels in blood associated with changes in serum biomarkers. | Outcome analysis presented in manuscript of results of trial based on 13 participants. | Posted | Count of Participants | Participants | 18 months |
|
|
|
| Other Pre-specified | Number of Participants With Systemic Humoral Anti-tumor Immune Response After Repeated Anti-TGFβ Antibody Instillation | Comparing antibody bands in pre-treatment versus post-treatment serum | Outcome analysis presented in manuscript of results of trial based on 13 participants. | Posted | Count of Participants | Participants | 18 months |
|
|
|
| Other Pre-specified | Assessment of Systemic TGFβ After Repeated Anti-TGFβ Antibody Installation | The number of participants with significant change in percentage of circulating CD4+ T regulatory cells, marked by expression of FOXP3 after treatment. TGFβ has been implicated in the formation of T regulatory cells, and the blockade of TGFβ in animal models can inhibit the formation of T regulatory cells. | Outcome analysis presented in manuscript of results of trial based on 13 participants. | Posted | Count of Participants | Participants | 18 months |
|
|
|
| Other Pre-specified | Biologic Response Measurements of TGFβ Blockade | Number of participants who demonstrated upregulation of NK cell receptors 3 weeks after treatment. There are data that show anti-TGFβ antibodies can upregulate NK cell receptors in patients with chronic viral infections. TGFβ blockade was measured in samples of serum tests and from pleural fluid or biopsy if available. | Outcome analysis presented in manuscript of results of trial based on 13 participants. | Posted | Count of Participants | Participants | 3 weeks |
|
|
|
| 12 |
| 14 |
| 6 |
| 14 |
| 12 |
| 14 |
| Hyponatremia | Metabolism and nutrition disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Neoplasms benign, malignant and unspecified (incl cysts and polyps) | Respiratory, thoracic and mediastinal disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Fatigue | Cardiac disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Thrombosis | Blood and lymphatic system disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Disease Progression | Respiratory, thoracic and mediastinal disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Fever | Blood and lymphatic system disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| General disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Ileus | Gastrointestinal disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Fatigue | Cardiac disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Dysphagia | Gastrointestinal disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Non-Cardiac Chest Pain | General disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Hoarseness | Respiratory, thoracic and mediastinal disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Epistaxis | Respiratory, thoracic and mediastinal disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Cough | Respiratory, thoracic and mediastinal disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Constipation | Gastrointestinal disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Dyspepsia | Gastrointestinal disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Nasal Congestion | Respiratory, thoracic and mediastinal disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Back Pain | Injury, poisoning and procedural complications | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Lung Infection | Infections and infestations | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Vomiting | Gastrointestinal disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Nausea | Gastrointestinal disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Hyponatremia | Metabolism and nutrition disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Anemia | Blood and lymphatic system disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Mucosal Infection | Infections and infestations | NCI CTCAE v.4.0 | Systematic Assessment |
|
| General disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Dry Skin | Skin and subcutaneous tissue disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Pruritis | Skin and subcutaneous tissue disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Pain | General disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Edema Limbs | General disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Chest Wall Pain | Musculoskeletal and connective tissue disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Rash maculo-papular | Skin and subcutaneous tissue disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Pericardial effusion | Cardiac disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Abdominal pain | Gastrointestinal disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Abdominal distension | Gastrointestinal disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
| Chest Pain | Cardiac disorders | NCI CTCAE v.4.0 | Systematic Assessment |
|
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| D009369 |
| Neoplasms |
| D018301 | Neoplasms, Mesothelial |
| D008175 | Lung Neoplasms |
| D012142 | Respiratory Tract Neoplasms |
| D013899 | Thoracic Neoplasms |
| D009371 | Neoplasms by Site |
| D010997 | Pleural Neoplasms |
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| Title | Measurements |
|---|---|
|
| Change in serum MMP-7 after treatment |
|
| Change in serum IL-6 V after treatment |
|
| Change in plasma CCL18 v after treatment |
|
| Change in plasma VEGF after treatment |
|
| Change in plasma PAI-1 after treatment |
|