Background:
- Patients with intermediate and high risk localized prostate cancer often receive
radiotherapy with androgen deprivation therapy as a potentially curative treatment.
With any local treatment for prostate cancer (radiation or surgery), as many as
20-30% of these intermediate and high risk patients will eventually develop
biochemical recurrence within 5 years of treatment.
- There is a growing body of evidence suggesting that stereotactic body radiation
therapy (SBRT), which delivers highly conformal high-dose radiation, can promote
anti-tumor immune responses both locally and systemically as well as synergize with
immune checkpoint inhibitors and other forms of immunotherapy. SBRT is now
considered a reasonable alternative to conventional fractionated external beam
radiation therapy (EBRT) by the National Comprehensive Cancer Network (NCCN)
guidelines and has rapidly proliferated in clinical use.
- M9241 (NHS-IL12) is an immunocytokine composed of two IL-12 heterodimers, each fused
to the H-chain of the NHS76 antibody. The NHS76 IgG1 antibody has affinity for both
single- and double-stranded DNA (dsDNA) allowing for targeted delivery of
proinflammatory cytokine, IL-12, to necrotic portions of tumor at sites of DNA
exposure to promote local immunomodulation.
- SBRT-induced dsDNA breaks are tumoricidal and may promote immunogenicity. SBRT also
upregulates PD-L1 expression and leads to activation of TGF-Beta. SBRT may enhance
intratumoral binding of DNA damage localizing agent, M9241. Preclinical models have
demonstrated impressive synergy with radiation plus M9241.
- This study will evaluate the proof of concept that immunocytokines can synergize
with standard radiation + ADT in prostate cancer with a focus on T-cell clonality.
Objectives:
- Safety Lead-In: To determine the safety and tolerated doses of the immunocytokine
M9241 and Stereotactic Body Radiation Therapy (SBRT) in participants with localized
high and intermediate risk prostate cancer receiving standard of care Androgen
Deprivation Therapy (ADT)
- To evaluate T-cell clonality, as a measure of immunologic activity, after treatment
with SBRT alone or in combination with immunotherapy agent M9241 in participants
with prostate cancer receiving standard of care ADT
Eligibility:
- Participants with intermediate or high risk localized prostate cancer
- Participants with no history of prior radiation to the prostate or prior
prostatectomy
- Participants without autoimmune disease or history of bleeding disorder
- Participants with adequate organ and bone marrow function
Design:
- This is an open label, randomized, Phase II trial evaluating T-cell clonality after
treatment with SBRT alone or in combination with immunotherapy agent M9241in
participants with localized intermediate or high risk prostate cancer receiving
standard of care ADT.
- The trial will begin with a safety lead-in cohort with de-escalating doses of M9241
(starting dose 16.8 mcg/kg, and de-escalated if needed to 12 mcg/kg, or 8 mcg/kg)
only if needed, to evaluate safety and tolerability of the combination of
treatments.
- ADT will be administered to all participants on the study as standard care.
- Those participants receiving immunotherapy agents will receive M9241 by subcutaneous
injection (sc) at a dose determined during the safety lead-in, every 4 weeks for 3
doses.
- To account for 3 inevaluable participants and 10 screen failures, the accrual
ceiling has been set at 65 participants (18 participants during the safety lead-in
phase, 34 during the randomized phase II portion).