Rovalpituzumab Tesirine (SC16LD6.5) in Recurrent Small Cell Lung Cancer

• Rovalpituzumab tesirine (SC16LD6.5) (Drug)

Primary outcomes

• Maximum Tolerated Dose (MTD) of Rovalpituzumab Tesirine [The DLT period was defined as either 21 or 42 days following the first dose of Rovalpituzumab tesirine during dose escalation (Phase 1a), depending on Cycle length.]: MTD was determined by testing increasing doses from 0.05 mg/kg up to 0.8 mg/kg on Day 1 of every 21-day or 42-day cycle, Phase 1a cohorts 1 to 8. MTD will be defined as the dose level immediately below the dose level at which ≥ 2 of the first 3 subjects per cohort (or ≥ 2 of 6 subjects) during the first cycle experience a study drug related dose limiting toxicity (DLT).

Secondary outcomes

• Objective Response Rate (ORR) [From first dose of rovalpituzumab tesirine to last event, up through study completion (on average approximately 4 months).]: Overall response was assessed at each visit post-baseline based on a subject's lesion measurements or assessments (complete response \[CR\], partial response \[PR\], stable disease \[SD\], progressive disease \[PD\], or not evaluable as defined by RECIST v1.1, plus an additional category of early death). The best overall response was then determined. A subject was defined as having an objective response if they had a best overall response of CR or PR prior to receiving any subsequent anticancer therapy; confirmed response is confirmation of CR or PR at least 4 weeks from the initial determination per RECIST v1.1. Subjects with a post-baseline assessment were included in the calculations for objective response rate (ORR). Outcome is based on data reported by Investigator (INV); available and evaluable radiographic scans were collected retrospectively for review by an Independent Review Committee (IRC).
• Duration of Response (DOR) [From first dose of Rovalpituzumab tesirine to last event timepoint, up through study completion (on average approximately 4 months, but up to 6.51 months).]: Duration of response (DOR) was defined as the number of months from the initial CR or PR to the time of disease progression or death, whichever occurred first. Outcome is based on data reported by Investigator (INV); available and evaluable radiographic scans were collected retrospectively for review by an Independent Review Committee (IRC).
• Clinical Benefit Rate (CBR) [From first dose of Rovalpituzumab tesirine to last event timepoint, up through study completion (on avergae approximately 4 months).]: Clinical Benefit is defined as a subject with best Overall Response of Complete Response (CR) or Partial Response (PR) or Stable Disease (SD) prior to receiving any subsequent anticancer therapy; as defined by RECIST version 1.1. CBR is defined as the proportion of subjects with Clinical Benefit based on assessment of overall response. CBR will be presented as a number and percentage with 95% confidence bounds. Any subjects not exhibiting a response (CR or PR or SD) are considered non-responders. Outcome is based on data reported by Investigator (INV); available and evaluable radiographic scans were collected retrospectively for review by an Independent Review Committee (IRC).
• Progression-free Survival (PFS) [From first dose of rovalpituzumab tesirine to last event timepoint, up through study completion (approximately 4 months on average, but up to 14.46 months).]: Progression-free survival (PFS) was defined as the number of months from the first day of study drug administration to disease recurrence or progression, or death on study. Outcome is based on data reported by Investigator (INV); available and evaluable radiographic scans were collected retrospectively for review by an Independent Review Committee (IRC).
• Overall Survival [From first dose of Rovalpituzumab tesirine to last event, up through study completion (on average approximately 5-7 months, but up to 14.6 months).]: Overall survival (OS) was defined as the time from the first day of study treatment to death. Subjects who were alive were censored at the date of last known alive.
• Maximum Serum Concentration (Cmax) of Rovalpituzumab Tesirine Antibody Drug Conjugate (ADC) [From Day 1 of first dose to End of Dose Cycle]: The maximum serum concentration (Cmax; measured in μg/mL) is the highest concentration that a drug achieves in the blood after administration in a dosing cycle.
• Area Under the Serum Concentration-time Curve (AUC) of Rovalpituzumab Tesirine ADC [From Day 1 of first dose to End of Dose Cycle]: The area under the serum concentration-time curve (AUC; measured in μg•d/mL) is a method of measurement to determine the total exposure of a drug in blood serum.

Sex: All, ages: 18 Years to any

Inclusion Criteria

1. Provision of informed consent
2. Male or female ≥18 years of age
3. Histologic or cytologic confirmed diagnosis of small cell lung cancer, either limited or extensive disease at initial presentation is allowed
4. Evidence of progressive disease during or following 1 or 2 prior chemotherapy regimens

   * At least 1 prior regimen must have contained a platinum salt
   * 'Adjuvant therapy' will constitute a prior treatment regimen
   * No more than 2 prior regimens are allowed
5. Measurable disease (only for the phase II portion)
6. Eastern Cooperative Oncology Group (ECOG) Performance status 0-1
7. A minimum life expectancy of 12 weeks
8. Adequate bone marrow, hepatic and renal function as evidenced by:

   * Absolute neutrophil count (ANC) ≥ 1.5 x 109/L
   * Platelet count ≥ 100 x 109/L
   * Hemoglobin ≥ 9.0 g/dL
   * Serum bilirubin < 1.5 x ULN
   * Aspartate aminotransferase (AST)/Alanine transferase (ALT) (SGOT/SGPT) < 2.5 x ULN for the reference laboratory or < 5 x ULN in the presence of liver metastases
   * Serum creatinine < 1.5 x ULN
9. No 'active' CNS metastases. Prior CNS metastases are allowed, provided adequate palliative therapy has been administered and CNS disease control has been established prior to study entry.

   • A brain MRI scan, ≤ 28 days from day 1, is required
10. Female patients who are not of child-bearing potential, and female patients of child-bearing potential who agree to use adequate contraceptive measures and who have a negative serum pregnancy test within 1 week prior to initial study treatment. (See Appendix B)
11. Male patients willing to use adequate contraceptive. (See Appendix B)
12. At least 21 days must have elapsed prior to day 1 cycle 1, from chemotherapy, radiotherapy, immunotherapy or following major surgery and any surgical incision should be completely healed. At least 14 days must have elapsed prior to Day 1 Cycle 1 for "limited palliative radiotherapy", defined as a course of therapy encompassing < 25% total bone marrow volume and not exceeding 30 Gy.
13. At least 14 days must have elapsed for chemotherapy regimens, biologic, and targeted therapy given continuously or on a weekly basis with limited potential for delayed toxicity.

Exclusion Criteria:

1. Patients who are pregnant or breastfeeding.
2. Active involvement of the Central Nervous System (CNS).
3. Uncontrolled infection or systemic disease.
4. Clinically significant cardiac disease not well controlled with medication (e.g., congestive heart failure, symptomatic coronary artery disease e.g. angina, and cardiac arrhythmias) or myocardial infarction within the last 12 months.
5. Chemotherapy regimens within the last 21 days (or within 6 weeks for prior nitrosourea or mitomycin C). Chemotherapy regimens, biologic, and targeted therapy given continuously or on a weekly basis with limited potential for delayed toxicity within the last 14 days.
6. No concurrent systemic chemotherapy or anticancer biologic therapy is allowed. Note: Patients on hormonal treatment for breast cancer or prostate cancer may continue on treatment and enter into study.
7. Known hypersensitivity to any components of SC16LD6.5 study drug product.
8. Patients with known human immunodeficiency virus (HIV) or Hepatitis B or C (active, previously treated or both), a history of solid organ or bone marrow transplantation would generally be considered to have met exclusion criteria, however exceptions may be considered on a case-by-case basis by the medical monitor.
9. Psychiatric disorder or social or geographic situation that would preclude study participation.
10. QT interval measurement corrected by Fridericia's formula (QTcF) interval of >450 msec (males) or >470 msec (females)

Participant flow

Outcome results

• Maximum Tolerated Dose (MTD) of Rovalpituzumab Tesirine (Primary), Number, mg/kg: Rovalpituzumab Tesirine 0.4
• Objective Response Rate (ORR) (Secondary), Number, percentage of subjects: SCLC Subjects 25 (14.98 to 38.44); LCNEC Subjects 0 (0 to 36.94)
• Duration of Response (DOR) (Secondary), Median, months: SCLC Subjects 2.89 (2.17 to 6.51); LCNEC Subjects
• Clinical Benefit Rate (CBR) (Secondary), Number, percentage of subjects: SCLC Subjects 73 (59.73 to 83.64); LCNEC Subjects 88 (47.35 to 99.68)
• Progression-free Survival (PFS) (Secondary), Median, months: SCLC Subjects 2.79 (2.33 to 3.71); LCNEC Subjects 3.07 (1.45 to 6.83)
• Overall Survival (Secondary), Median, months: SCLC Subjects 4.76 (4.01 to 7.13); LCNEC Subjects 6.59 (2.89 to 14.46)
• Maximum Serum Concentration (Cmax) of Rovalpituzumab Tesirine Antibody Drug Conjugate (ADC) (Secondary), Geometric mean, μg/mL: Phase 1a: Cohort 1 1.27 +/- 13; Phase 1a: Cohort 2 2.42; Phase 1a: Cohort 3 5.08 +/- 21; Phase 1a: Cohort 4 8.81 +/- 7; Phase 1a: Cohort 5 18.8 +/- 27; Phase 1a: Cohort 6 11.4 +/- 27; Phase 1a: Cohort 7 7.67 +/- 21; Phase 1a: Cohort 8 5.36 +/- 26
• Area Under the Serum Concentration-time Curve (AUC) of Rovalpituzumab Tesirine ADC (Secondary), Geometric mean, μg•d/mL: Phase 1a: Cohort 1 12.3 +/- 22; Phase 1a: Cohort 2 26.3; Phase 1a: Cohort 3 45.6 +/- 32; Phase 1a: Cohort 4 97.3 +/- 21; Phase 1a: Cohort 5 142 +/- 18; Phase 1a: Cohort 6 107 +/- 28; Phase 1a: Cohort 7 64.8 +/- 36; Phase 1a: Cohort 8 45.0 +/- 34

Adverse events

Time frame: From date of first dose through 30-days following last dose (on average 85 days).

Serious adverse events by term

Other adverse events by term

12 more terms not shown.

• Results publication: Rudin CM, Pietanza MC, Bauer TM, Ready N, Morgensztern D, Glisson BS, Byers LA, Johnson ML, Burris HA 3rd, Robert F, Han TH, Bheddah S, Theiss N, Watson S, Mathur D, Vennapusa B, Zayed H, Lally S, Strickland DK, Govindan R, Dylla SJ, Peng SL, Spigel DR; SCRX16-001 investigators. Rovalpituzumab tesirine, a DLL3-targeted antibody-drug conjugate, in recurrent small-cell lung cancer: a first-in-human, first-in-class, open-label, phase 1 study. Lancet Oncol. 2017 Jan;18(1):42-51. doi: 10.1016/S1470-2045(16)30565-4. Epub 2016 Dec 5. PMID 27932068

• Donald Strickland, MD, Study director, SCRI Innovations