ZW25 for the Treatment of HER2 Overexpressed Recurrent or Refractory Endometrial Cancers and Carcinosarcomas
- Patients must be enrolled or agree to consent to the companion genomic profiling study Memorial Sloan Kettering Cancer Center (MSKCC) Institutional Review Board (IRB)# 12-245 Part A. Results are not required prior to initiating treatment on protocol, unless patients do not have other test results by IHC or fluorescent in situ hybridization (FISH) confirming HER2 overexpression
- Patients must have recurrent or persistent HER2 overexpressing endometrial cancer or endometrial carcinosarcoma. HER2 overexpression is defined as 3+ by IHC or 2+ with gene amplification by FISH (HER2/CEP17 ratio >= 2) or HER2 amplified (fold change >= 2) on MSK IMPACT
- Histologic documentation of diagnosis of endometrial carcinoma or carcinosarcoma is required
- Patients must have had at least one but no more than two prior chemotherapeutic regimens for management of endometrial carcinoma (including neo-adjuvant and/or adjuvant chemotherapy). Initial treatment may include chemotherapy, chemotherapy and radiation therapy, and/or consolidation/maintenance therapy. Chemotherapy administered in conjunction with primary radiation as a radio-sensitizer WILL be counted as a systemic chemotherapy regimen. Prior hormonal therapy will not count as a prior regimen. Prior treatment with trastuzumab is allowed
- Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
- Left ventricular ejection fraction (LVEF) >= 50% on baseline screening echocardiogram (ECHO)
- Resolution of adverse effects of recent surgery, radiotherapy, or chemotherapy to grade =< 1 prior to first study treatment (with the exception of alopecia or clinically insignificant laboratory values)
- Patients must have measurable disease. Measurable disease is defined by RECIST (version 1.1). Measurable disease is defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded). Each non-nodal lesion must be >=10 mm when measured by computed tomography (CT), magnetic resonance imaging (MRI) or caliper measurement by clinical exam; or >=20 mm when measured by chest x-ray. Lymph nodes must be >= 15 mm in short axis when measured by CT or MRI
- No active infection requiring antibiotics (with the exception of uncomplicated urinary tract infection)
- Patients must be willing to provide an archival tumor block or tissue slides (at least 10-20 formalin-fixed paraffin-embedded [FFPE] slides)
- All patients must consent to mandatory pre-treatment and post-treatment core needle biopsies
- Absolute neutrophil count (ANC) >= 1.5 x 10^9/L (> 1500 per mm^3) (within 14 days prior to first treatment)
- Platelet >= 100 x 10^9/L (> 100,000 per mm^3) (within 14 days prior to first treatment)
- Hemoglobin >= 8.0 g/dL (within 14 days prior to first treatment)
- Serum bilirubin =< 1.5 x institutional upper limit of normal (ULN) (within 14 days prior to first treatment). (Unless Gilbert’s syndrome, for which bilirubin =< 3 x institutional upper limit of normal [ULN], without concurrent clinically significant liver disease)
- Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase [SGPT]) =< 3 x institutional upper limit of normal (ULN) (within 14 days prior to first treatment) unless liver metastases are present, in which case it must be =< 5 x ULN
- Serum creatinine =< 1.5 x institutional upper limit of normal (ULN) (within 14 days prior to first treatment)
- For patients of childbearing potential, agreement to use two effective forms of contraception (e.g., surgical sterilization, a reliable barrier method, birth control pills, or contraceptive hormone implants) and to continue its use for the duration of the study and for 12 weeks after the last ZW25 dose
- Agree to practice total abstinence when this is in line with the preferred and usual lifestyle of the subject. * A woman is considered to be of childbearing potential unless 1 of the following applies: She is considered to be permanently sterile. Permanent sterilization methods include hysterectomy, bilateral salpingectomy, tubal ligation, and bilateral oophorectomy * She is postmenopausal, defined as no menses for 12 months without an alternative medical cause. A high follicle-stimulating hormone (FSH) level consistently in the postmenopausal range (30 mIU/mL or higher) may be used to confirm a postmenopausal state in women not using hormonal contraception or hormonal replacement therapy; however, in the absence of 12 months of amenorrhea, a single FSH measurement is insufficient to confirm a postmenopausal state * Female patients of childbearing potential must have a negative serum pregnancy test result less than 3 day prior to administration of the first dose of study treatment
- Patients or their legally authorized representative (LAR) must be willing and able to sign the informed consent form, and to adhere to the study visit schedule and other protocol requirements
- Women who are pregnant or lactating or women of childbearing potential (WCBP) not protected by highly-effective contraceptive methods
- > grade 1 peripheral neuropathy
- History of hemorrhagic or ischemic stroke within the prior six months
- History of New York Heart Association (NYHA) class II-IV heart failure, no serious arrhythmia
- History of myocardial infarction (MI) or unstable angina within 6 months of study initiation
- Patients with a lifetime cumulative dose of anthracycline > 300 mg/m^2 or who have received anthracycline treatment within 90 days of the expected first dose of ZW25 are not eligible for treatment
- Prior hypersensitivity to monoclonal antibodies
- Active hepatitis B or hepatitis C infection. Patients with previously resolved hepatitis B infection are eligible. Presence of positive test results for hepatitis B infection who have resolved the infection (defined by positive for HB surface antibody (anti-HBs) and polymerase chain reaction (PCR) assay is negative for hepatitis B virus (HBV) DNA are eligible. Patients positive for hepatitis C virus (HCV) antibody are eligible only if testing for HCV ribonucleic acid (RNA) is negative
- Known human immunodeficiency virus (HIV) infection
- Current severe, uncontrolled systemic disease (e.g., clinically significant cardiovascular, pulmonary, or metabolic disease)
- Major surgical procedure or significant traumatic injury within 28 days prior to day 1 or anticipation of the need for major surgery during the course of study treatment
- Known untreated or active central nervous system (CNS) metastases (progressing or requiring anticonvulsants or corticosteroids for symptomatic control) leptomeningeal carcinomatosis. Patients with a history of treated CNS metastases are eligible, provided that they meet all of the following criteria: * Presence of measurable disease outside the CNS * No radiographic evidence of worsening upon the completion of CNS directed therapy and no evidence of interim progression between the completion of CNS-directed therapy and the screening radiographic study * No history of intracranial hemorrhage or spinal cord hemorrhage * No ongoing requirement for dexamethasone as therapy for CNS disease (anticonvulsants at a stable dose are allowed) * Absence of leptomeningeal disease
- Inability to comply with study and follow-up procedures
- Known allergy or hypersensitivity to the components of ZW25 formulation
- Any other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding that, in the investigator’s opinion, gives reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug or that may affect the interpretation of the results or render the patient at high risk from treatment complications
- Active or history of inflammatory bowel disease (IBD)
- Severe infections within 4 weeks prior to initiation of study drug treatment, including but not limited to hospitalization for complications of infection, bacteremia, or severe pneumonia
- Treatment with therapeutic oral or IV antibiotics within 2 weeks prior to initiation of study treatment. Patients receiving prophylactic antibiotics (e.g., for prevention of urinary tract infection or to prevent chronic obstructive pulmonary disease exacerbation) are eligible for the study. Patients receiving antibiotic treatment for urinary tract infection are also eligible
- Administration of a live attenuated vaccine within 4 weeks prior to initiation of study treatment or anticipated need for such a vaccine during study. Patients must agree not to receive live, attenuated influenza vaccine (e.g., Flumist) within 4 weeks prior to treatment
- Participation in another clinical study with receipt of an investigational product during the last 4 weeks
- History of another primary malignancy except for: * Malignancy treated with curative intent and with no known active disease >= 2 years before the first dose of study drug and of low potential risk for recurrence * Adequately treated non-melanoma skin cancer or lentigo maligna without evidence of disease * Adequately treated carcinoma in situ without evidence of disease (e.g., cervical cancer in situ) * Adequately treated stage 1 breast cancer
- Receipt of the last dose of anti-cancer therapy (chemotherapy, immunotherapy, targeted therapy, biologic therapy, tumor embolization, monoclonal antibodies) < 21 days prior to the first dose of study drug. Receipt of the last dose of hormonal therapy within < 7 days prior to the first dose of study drug
- Any prior radiation therapy must be discontinued at least four weeks prior to registration
- QT interval corrected for heart rate (QTc) >= 470 ms on screening electrocardiograms (ECG)
- History of small or large bowel obstruction within 3 months of registration, including subjects with palliative gastric drainage catheters. Subjects with palliative diverting ileostomy or colostomy are allowed if they have been symptom free for more than 3 months
- Subjects with refractory ascites, defined as ascites needing drainage catheter or therapeutic paracentesis more often than every 4 weeks
- Ongoing bowel perforation or presence of bowel fistula or abscess within 3 months of registration
I. To determine overall response rate (ORR = complete response [CR] + partial response [PR]) by Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v 1.1) =< 24 weeks from the start of treatment.
I. To determine progression free survival (PFS) rate at 24 weeks.
II. To determine clinical benefit rate (CBR) by 24 weeks.
III. To determine PFS and overall survival (OS).
IV. To determine duration of response (DOR).
V. To determine the rate of serious adverse events (SAE) of anti-HER2/HER2 bispecific antibody ZW25 (ZW25) by Common Terminology Criteria for Adverse Events version 5 (CTCAE v 5.0)
I. Anti-drug antibodies (ADA) will be assessed at, baseline, pre-dose for day 1 in the first 2 cycles and then prior to the start of first dose for every even numbered cycle.
II. To explore the molecular associations between the HER2 biomarkers: gene amplification (by next generation sequencing [NGS] and in situ hybridization [ISH]), protein overexpression by immunohistochemistry (IHC) and mutational status and/or copy # variations of relevant cancer-related genes using Memorial Sloan Kettering -Integrated Mutation Profiling of Actionable Cancer Targets (MSK-IMPACT) platform in all patients with new research biopsies collected under this protocol, and to determine mechanisms of underlying response and resistance.
III. To examine ORR in each cohort by different types of molecular alterations, HER2 amplification (by NGS and ISH separately), mutation and HER2 overexpression, and assess genomic changes with response for potential predictive signatures.
IV. To evaluate the predictive value of changes in circulating tumor deoxyribonucleic acid (DNA) variant allele frequency during treatment for response to ZW25.
OUTLINE: This is a dose-escalation study.
Patients receive ZW25 intravenously (IV) over 60-150 minutes on days 1 and 15. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up at 7 days, 30 days, and then every 3 months for 2 years.
Trial Phase Phase II
Trial Type Treatment
Memorial Sloan Kettering Cancer Center
- Primary ID 20-162
- Secondary IDs NCI-2020-06405
- Clinicaltrials.gov ID NCT04513665