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This is a multicenter, single-arm, open, dose-escalation Phase I/II clinical trial, consisting of a dose-escalation phase (accelerated titration phase, 3+3 design) and a dose expansion phase.
Based on the safety, tolerability, PK results, and antitumor activity of EX103 in patients with relapsed or refractory CD20-positive non-Hodgkin lymphoma, this study will determine dose-limiting toxicity (DLT) and determine the maximum tolerated dose (MTD) or optimal biological dose (OBD) to provide a basis for the recommended Phase 2 dose (RP2D). The dose expansion phase will further evaluate the safety, tolerability, PK, PD profile, initial antitumor effect, and immunogenicity of several extended cohorts.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| EX103 injection | Experimental | From Cycle 0 to Cycle 2, the subject will receive the preset dose of EX103 once a week (QW), and from Cycle 3, the subject will receive the preset dose of EX103 once every two weeks (Q2W). The recommended dose is MTD or OBD, and a cycle of treatment is 28 days. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| EX103 injection | Drug | Administered as specified in the treatment arm. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of Dose Limiting Toxicities (DLTs) [dose escalation (Cycle 0 and Cycle 1)] | To determine the RP2D and the MTD, if reached. | During the DLT evaluation period (28 days from Cycle1 Day1 at the dose escalation stage). |
| Safety endpoints:incidence and severity of adverse events (AE), laboratory tests, etc. | Treatment-emergent AEs (TEAEs) as assessed by CTCAE v5.0. Abnormal laboratory values are reported as AEs per protocol. | From first dose until the end of the safety follow-up period [within 28 ± 7 days after the last study treatment or before the start of other anti-tumor treatments (whichever occurs earlier)]. |
| Measure | Description | Time Frame |
|---|---|---|
| All parts: Time to reach Cmax (Tmax) | Tmax is one of the characteristics of Pharmacokinetic (PK) endpoint. | From first dose until treatment discontinuation, expected average of 3.5 years. |
| All parts: Maximum (peak) plasma concentration (Cmax) |
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Inclusion Criteria:
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1. Provision of signed and dated informed consent form; stated willingness to comply with all study procedures and availability for the duration of the study; 2. Aged ≥ 18 years old, male or female; 3. Meeting the following criteria:
(i) Cohort 1:
(ii) Cohort 2:
(iii) Cohort 3:
4. At the dose escalation and expansion stages, the subjects must have at least one two- dimensionally measurable lesion as the basis for evaluation by CT, or MRI, if CT is not applicable: for intranodal lesions, the long diameter is ≥ 1.5 cm; for extranodal lesions, the long diameter is ≥ 1.0 cm;
5. ECOG performance status score: 0-2;
6. Life expectancy ≥ 12 weeks;
7. The laboratory test results should be met before each cycle beyond cycle 1 (blood components, short-acting cell growth factors, albumin, and other drugs are not allowed to be given within the first 7 days of laboratory tests; long-acting cell growth factors are not allowed to be given within the first 14 days):
Absolute neutrophil count ≥ 1.0×109/L;
Platelet count ≥ 50×109/L;
Hemoglobin ≥ 80 g/L;
Serum total bilirubin ≤ 1.5×ULN; if there is liver invasion, serum total bilirubin ≤ 3×ULN;
Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 2.5×ULN; if there is liver invasion, ALT and AST ≤ 5×ULN;
Serum creatinine ≤1.5×ULN or creatinine clearance estimated by Cockcroft-Gault formula ≥ 30 mL/min;
International normalized ratio (INR) or plasma prothrombin time (PT) ≤ 1.5×ULN;
8. Women of childbearing potential and men with a partner of childbearing potential who consent to use highly effective methods of birth control during treatment and for an additional 90 days after the last administration of the protocol specified treatment; women of childbearing age without surgical sterilization must have a negative result in serum HCG test within 7 days before enrollment in the study and isn't breastfeeding.
Exclusion Criteria:
Clear history of drug allergy, foreign protein, biologics or ingredients of investigational drugs;
Uncontrolled active infection during the screening period;
Previously received allogeneic hematopoietic stem cell transplantation or solid organ transplant; or received autologous hematopoietic stem cell transplantation (HSCT) or CAR-T cell therapy within 3 months;
CNS metastases, or other serious central nervous system diseases (such as epilepsy, cerebral infarction, and cerebral hemorrhage) within 6 months, History of neurodegenerative condition or CNS movement disorder. Subjects with a history seizure within 12 months prior to study enrollment are excluded;
At least one active person is known to have human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV). Subjects with evidence below are eligible for study entry:
Toxicities caused by previous anti-tumor therapy has not recovered to grade ≤ 1 (CTCAE v5.0), except alopecia and other tolerable events as determined by the investigator;
Develop any other malignancy within 5 years (except for completely treated cervical carcinoma in situ or basal cell or squamous cell skin cancer);
Use of any vaccine within 4 weeks prior to initial pretreatment with dexamethasone or methylprednisolone or during the intended study period;
Systemic immunosuppressive drugs, including but not limited to radiotherapy immune conjugate, antibody drug conjugations, immune/cytokines, monoclonal antibodies, etc., have been used within 4 weeks prior to initial pretreatment with dexamethasone or methylprednisolone.
With a history of active autoimmune diseases, including but not limited to myocarditis, pneumonia, myasthenia gravis, autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, Wegener's granulomatosis, multiple sclerosis, vasculitis, or glomerulonephritis;
Any condition that the investigator believes may not be appropriate for participating in the study.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Jiali Lu, MD, PHD | Contact | 86-02028211020 | jiali.lu@excelmab.com | |
| Yanfei Li | Contact | 86-13242086880 | yanfei.li@excelmab.com |
| Name | Affiliation | Role |
|---|---|---|
| Junyuan Qi, MD, PHD | Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Cancer Hospital Affiliated to Zhengzhou University, Henan Cancer Hospital | Recruiting | Zhengzhou | Henan | 450000 | China |
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Cmax is one of the characteristics of Pharmacokinetic (PK) endpoint.
| From first dose until treatment discontinuation, expected average of 3.5 years. |
| All parts: Area under the concentration-time curve from time 0 to the last measurable concentration using linear-log trapezoidal rule (AUC0-t) | AUC0-t is one of the characteristics of Pharmacokinetic (PK) endpoint. | From first dose until treatment discontinuation, expected average of 3.5 years. |
| All parts: Elimination half-life (t 1/2) | t 1/2 is one of the characteristics of Pharmacokinetic (PK) endpoint. | From first dose until treatment discontinuation, expected average of 3.5 years. |
| All parts: Total body clearance of drug from the plasma (CL) | CL is one of the characteristics of Pharmacokinetic (PK) endpoint. | From first dose until treatment discontinuation, expected average of 3.5 years. |
| All parts: Steady-state maximum plasma concentration(Css,max) | Css,max is one of the characteristics of Pharmacokinetic (PK) endpoint. | From first dose until treatment discontinuation, expected average of 3.5 years. |
| All parts: Steady-state minimum plasma concentration(Css,min) | Css,min is one of the characteristics of Pharmacokinetic (PK) endpoint. | From first dose until treatment discontinuation, expected average of 3.5 years. |
| All parts: Steady-state time to maximum concentration(Tss,max) | Tss,max is one of the characteristics of Pharmacokinetic (PK) endpoint. | From first dose until treatment discontinuation, expected average of 3.5 years. |
| All parts: Area under the plasma concentration versus time curve at Steady-State(AUCss) | AUCss is one of the characteristics of Pharmacokinetic (PK) endpoint. | From first dose until treatment discontinuation, expected average of 3.5 years. |
| All parts: Pharmacodynamic (PD) endpoint | Before and after administration of EX103, changes in lymphocyte subsets and peripheral blood cytokine levels. | From first dose until treatment discontinuation, expected average of 3.5 years. |
| All parts: Objective response rate (ORR) | ORR is defined as the proportion of subjects whose optimal response is CR or CRi or PR. Subjects who did not undergo tumor evaluation after baseline were considered to have no objective, as determined by the investigator using Lugano 2014 criteria. | From first dose until treatment discontinuation, expected average of 3.5 years. |
| All parts: Disease control rate (DCR) | DCR is defined as the proportion of subjects whose best response is CR or CRi or PR or SD. | From first dose until treatment discontinuation, expected average of 3.5 years. |
| All parts: Duration of response (DoR) | Duration of response (DoR) is defined as the time between the first onset of CR or CRi or PR and the onset of PD or death from any cause, whichever occurs first, in subjects with objective response. | From first dose until treatment discontinuation, expected average of 3.5 years. |
| All parts: Incidence of anti-drug antibodies (ADA) | Percentage of positive patients of anti-drug antibody. | From first dose until treatment discontinuation, expected average of 3.5 years. |
| All parts: Incidence of neutralizing antibody (NAb) | Percentage of positive patients of neutralizing antibody. | From first dose until treatment discontinuation, expected average of 3.5 years. |
| All parts: Confirmation of anti-drug antibody and neutralizing antibodies. | Screening of antibodies against corresponding antigens and confirmation of positive antibodies, and determination of the titers of related antibodies (IgG, etc.) produced in the humoral and cellular immunity. | From first dose until treatment discontinuation, expected average of 3.5 years. |
| Qilu Hospital, Cheeloo College of Medicine, Shandong University | Recruiting | Jinan | Shandong | 250012 | China |
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| Shanghai Sixth People's Hospital, Shanghai Jiaotong University school of Medicine | Recruiting | Shanghai | Shanghai Municipality | 200233 | China |
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| Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences | Recruiting | Tianjin | Tianjin Municipality | 300020 | China |
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