DCC-3014 and Avelumab for the Treatment of Locally Advanced or Metastatic High-Grade Sarcoma

Inclusion Criteria

• Age >= 18 years at the time of informed consent
• Be capable, willing, and able to provide written informed consent/assent
• Be willing to comply with clinical trial instructions and requirements, including mandatory biopsies
• Dose escalation phase: Patients must have a histologically confirmed metastatic and/or locally advanced high grade sarcoma
• Dose expansion phase: Patients must have a histologically confirmed metastatic and/or locally advanced undifferentiated pleomorphic sarcoma, myxofibrosarcoma, leiomyosarcoma, or dedifferentiated liposarcoma
• Eastern Cooperative Oncology Group (ECOG) 0 or 1/Karnofsky performance status (KPS) 100-70%
• Patients must have at least one prior line of systemic therapy (e.g. chemotherapy, targeted or biological therapy) for their sarcoma. Prior neoadjuvant and/or adjuvant therapy w ill count regardless of when it w as completed. Treatment naïve patients can enroll if they refuse standard of care systemic chemotherapy
• Presence of measurable disease per RECIST v1.1.Target lesions must not be chosen from a previously irradiated field unless there has been radiographically and/or pathologically documented tumor progression in that lesion prior to enrollment
• Absolute neutrophil count (ANC) >= 1,500/mcL (determined within 28 days of treatment initiation)
• Platelets >= 100,000/mcL (determined within 28 days of treatment initiation)
• Serum creatinine =< 1.5 X upper limit of normal (ULN) OR measured or calculated creatinine clearance (glomerular filtration rate [GFR] can also be used in place of creatinine or creatinine clearance [CrCl]) >= 60 mL/min for patient with creatinine levels > 1.5 X institutional ULN (determined within 28 days of treatment initiation)
• Serum total bilirubin =< 1.5 X ULN OR direct bilirubin =< ULN for patients with total bilirubin levels > 1.5 ULN (determined within 28 days of treatment initiation)
• Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 X ULN OR =< 5 X ULN for patients with liver metastases (determined within 28 days of treatment initiation)
• Albumin >= 3 mg/dL (determined within 28 days of treatment initiation)
• International normalized ratio (INR) or prothrombin time (PT) =< 1.5 X ULN unless patient is receiving anticoagulant therapy as long as PT or partial thromboplastin time (PTT) is within therapeutic range of intended use of anticoagulants =< 1.5 X ULN unless patient is receiving anticoagulant therapy as long as PT or PTT is within therapeutic range of intended use of anticoagulants (determined within 28 days of treatment initiation)
• Activated partial thromboplastin time (aPTT) =< 1.5 X ULN unless patient is receiving anticoagulant therapy as long as PT or PTT is within therapeutic range of intended use of anticoagulants =< 1.5 X ULN unless patient is receiving anticoagulant therapy as long as PT or PTT is within therapeutic range of intended use of anticoagulants (determined within 28 days of treatment initiation)
• Women of childbearing potential (defined as a sexually mature female who has not undergone a hysterectomy or bilateral oophorectomy or who has not been naturally postmenopausal for at least 24 consecutive months) must have a negative urine or serum pregnancy test at screening and =< 72 hours prior to day 1 of study treatment. If the urine pregnancy test is positive or cannot be confirmed as negative, a serum pregnancy test will be required
• Male and female patients of childbearing potential must be willing to use a highly effective method of contraception, for at least 30 days prior to the first dose of DCC-3014 and through 7 months after the last dose of study medication. Abstinence is acceptable if this is the usual lifestyle and preferred contraception for the patient. Lactating women must be willing to not breastfeed during treatment and for at least one month after the last dose of avelumab

Exclusion Criteria

• History of unstable or deteriorating cardiovascular disease within the previous 6 months prior to screening including but not limited to the following: * Unstable angina or myocardial infarction * Cerebrovascular accident (CVA)/stroke * Congestive heart failure (New York Heart Association [NYHA] class III or IV) * Uncontrolled clinically significant arrhythmias
• Evidence of clinically significant interstitial lung disease or active, noninfectious pneumonitis related to prior immunotherapy treatment
• Malabsorption syndrome or other illness that could affect oral absorption
• Has known active central nervous system (CNS) metastases and/or carcinomatous meningitis. Patients with previously treated brain metastases or carcinomatous meningitis may participate provided they are stable (without evidence of progression by imaging for at least four weeks prior to the first dose of trial treatment and any neurologic symptoms have returned to baseline), have no evidence of new or enlarging brain metastases, and are not using steroids for at least 7 days prior to trial treatment
• Current use of immunosuppressive medication, EXCEPT for the following: * Intranasal, inhaled, topical steroids, or local steroid injection (e.g., intraarticular injection) * Systemic corticosteroids at physiologic doses =< 10 mg/day of prednisone or equivalent * Steroids as premedication for hypersensitivity reactions (e.g., computed tomography [CT] scan premedication)
• Evidence of clinically significant immunosuppression such as the following: * Primary immunodeficiency state such as severe combined immunodeficiency disease * Concurrent opportunistic infection * Receiving systemic immunosuppressive therapy (> 2 weeks) including oral steroid doses > 10 mg/day of prednisone or equivalent within 2 months prior to enrollment
• History or evidence of symptomatic autoimmune disease (e.g., pneumonitis, glomerulonephritis, vasculitis, or other), or history of active autoimmune disease that has required systemic treatment (i.e., use of corticosteroids, immunosuppressive drugs or biological agents used for treatment of autoimmune diseases) in past 2 years prior to enrollment. Replacement therapy (e.g., thyroxine for hypothyroidism, insulin for diabetes or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency) is not considered a form of systemic treatment for autoimmune disease
• Known history of human immunodeficiency virus (HIV) (HIV 1/2 antibodies) disease that is not controlled
• Patients known to be positive for active hepatitis B (hepatitis B surface antigen [HBsAg] reactive with detectable hepatitis B virus [HBV] deoxyribonucleic acid [DN]A), or hepatitis C (HCV ribonucleic acid [RNA] (qualitative) is detected) * Patients with chronic hepatitis B (positive HBsAg and/or hepatitis B virus core antibody [HBcAb] and negative HBV DNA by polymerase chain reaction [PCR]) are eligible for this study if deemed safe by a gastroenterologist
• Prolonged Fridericia's correction formula (QTcF) > 450 ms for men and > 470 ms for women at screening
• Patients who have received a live vaccine within 30 days of the start date of the planned study therapy. Note: Seasonal influenza vaccines for injection are generally inactivated flu vaccines and are allowed; however intranasal influenza vaccines (e.g., Flu-Mist) are live attenuated vaccines, and are not allowed
• Has a known history of active TB (Bacillus tuberculosis)
• Is currently participating and receiving study therapy or has participated in a study of an investigational agent and received study therapy or used an investigational device within 4 weeks of the first dose of treatment
• Has had a prior anti-cancer monoclonal antibody (mAb) within 3 weeks prior to study day 1 or who has not recovered (i.e., =< grade 1 or at baseline) from adverse events due to agents administered more than 4 weeks earlier
• Has had prior chemotherapy, targeted small molecule therapy, or radiation therapy within 2 weeks prior to study day 1 or who has not recovered (i.e., =< grade 1 or at baseline) from adverse events due to a previously administered agent * Note: Alopecia, neuropathy grade =< 2, or other grade =< 2 not constituting a safety risk based on investigator’s judgment are acceptable * Note: If patient received major surgery, they must have recovered adequately from the toxicity and/or complications from the intervention prior to starting therapy events due to a previously administered agent
• Patients who have received prior treatment with an anti-PD-1/PD-L1 agent
• Women who are pregnant or breast feeding
• Patients expecting to conceive or father children within the projected duration of the trial, starting with the pre-screening or screening visit through 120 days after the last dose of study treatment(s)
• Prior organ transplantation including allogenic stem-cell transplantation
• Active infection requiring systemic therapy
• Known prior severe hypersensitivity to investigational product or any component in its formulations, including known severe hypersensitivity reactions to monoclonal antibodies (National Cancer Institute [NCI] Common Terminology Criteria for Adverse Events [CTCAE] v4.03 grade >= 3)
• Other severe acute or chronic medical conditions including immune colitis, inflammatory bowel disease, immune pneumonitis, pulmonary fibrosis or psychiatric conditions including recent (within the past year) or active suicidal ideation or behavior; or laboratory abnormalities that may increase the risk associated with study participation or study treatment administration or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the patient inappropriate for entry into this study