Background:
- Kaposi Sarcoma (KS) is a multicentric angioproliferative tumor, caused by Kaposi
sarcoma-associated herpesvirus, that most frequently involves the skin, but may also
involve lymph nodes, lungs, bone and gastrointestinal tract. It is most common in
people with HIV but may also occur in patients without a diagnosis of HIV. Patients
with HIV-associated KS have worse survival than HIV-infected patients without KS.
- As it is a relapsing and remitting condition, patients with KS often require
prolonged courses of cytotoxic chemotherapy.
- KS is an immune responsive tumor as interferon-alpha, pomalidomide, and restoring
T-cell function in HIV + patients treated with antiretroviral drugs can result in
clinical benefit and remission of KS.
- Published Phase I/II studies by our group demonstrated that IL-12 alone and in
combination with liposomal doxorubicin led to clinical responses in patients with
advanced KS.
- PDS01ADC is an immunocytokine with affinity to both single and double stranded DNA
allowing for targeting of exposed DNA, which is commonly seen in necrotic tumors.
This agent is able to deliver IL-12 to the tumor microenvironment promoting local
immunomodulation, that results in less systemic toxicity than IL-12 systemic
administration.
- M7824 is a novel bifunctional fusion protein composed of a monoclonal antibody
against human PD-L1 (avelumab) fused with the extracellular domain of human TGF-beta
receptor II (TGF-betaRII), which functions as a TGF-beta trap .
- Anti-PD-L1 and anti-PD-1 agents have been found to be active in certain
virus-induced cancers, including Kaposi sarcoma, and to be safe and active in
patients with HIV infection.
- Currently, no clinical data exists for the combination of PDS01ADC and M7824.
Preclinical data suggest synergy between these agents from existing ongoing studies
and the available clinical data both in KS and other tumor subtypes suggest that the
combination of PDS01ADC with M7824 is likely to be well-tolerated and has scientific
rationale. This combination offers a new treatment approach for patients with
advanced KS who have received prior therapies.
Objectives:
-Evaluate the safety, tolerability, and activity of single agent PDS01ADC and the
combination of PDS01ADC with M7824 in participants with advanced KS
Eligibility:
- Age >=18 years
- Histologically confirmed Kaposi sarcoma (KS)
- KS requiring systemic therapy, with or without a history of prior systemic therapy
- At least five measurable cutaneous KS lesions with no previous local radiation,
surgical or intralesional cytotoxic therapy to these measurable lesions.
- ECOG Performance Status (PS) <= 2
- Participant must be willing to give informed consent.
- Participants can be HIV positive or negative.
- Antiretroviral therapy (ART) for HIV+ participants for 8 or more weeks prior to
entry with an HIV viral load of <400 copies/ml and CD4+ T-cell count >50
cells/microliter.
- Participants with bleeding from visceral sites of KS or requiring blood transfusions
in the 2 weeks prior to study entry will not be eligible.
Design:
- This is a Phase I/II study assessing the safety and efficacy of PDS01ADC alone or in
combination with M7824 in participants with advanced KS. Participants will receive
therapy until optimal tumor response, unacceptable toxicity, the participant s
request to discontinue therapy, PI decision, up to a total of 96 weeks, or 24
cycles.
- Monotherapy: Participants with history of prior systemic therapy will receive
PDS01ADC alone with a 3+3 design applicable to the first 3-6 participants at a
starting dose of 16.8 microgram/kg on day 1 of a 28-day cycle. Two dose
de-escalation levels (Dose Level -1: 12 microgram/kg or Dose Level -2: 8
microgram/kg) will be permitted if there is evidence of 2 or more dose limiting
toxicities within the first 6 weeks of therapy. An expansion cohort will investigate
the activity of PDS01ADC in participants with and without prior systemic therapy for
KS.
- Combination Therapy: The combination arm will open following accrual and completion
of the DLT period for participants in the monotherapy arm. Up to 28 participants
will be treated with M7824 (1200 mg IV, every 2 weeks) and PDS01ADC (MTD dose from
the monotherapy arm). The DLT period for this arm will be 6 weeks.