A Phase 2 Study of Sitravatinib in Combination With PD-(L)1 Checkpoint Inhibitor Regimens in Patients With Advanced or Metastatic Urothelial Carcinoma

NCT ID: NCT03606174

Last Updated: 2023-08-24

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE2

Total Enrollment

260 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-09-11

Study Completion Date

2022-08-22

Brief Summary

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The study will evaluate the clinical activity of PD-(L)1 Checkpoint Inhibitor regimens in combination with the investigational agent sitravatinib in patients with advanced or metastatic urothelial carcinoma.

Detailed Description

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Sitravatinib is an orally-available, small molecule inhibitor of a closely related spectrum of receptor tyrosine kinases (RTKs) including MET, Axl, MERTK, VEGFR family, PDGFR family, KIT, FLT3, Trk family, RET, DDR2 and selected Eph family members. Nivolumab is a human IgG monoclonal antibody that binds to the programmed cell death-1(PD-1) receptor and blocks its interaction with programmed cell death ligand-1 (PD-L1) and PD-L2, releasing PD-1 pathway-mediated inhibition of the immune response including anti-tumor immune response. Combining an immunotherapeutic PD-L1 checkpoint inhibitor with an agent that has both immune modulatory and antitumor properties could enhance the antitumor efficacy observed with either agent alone. Sitravatinib selectively inhibits key molecular and cellular pathways strongly implicated in checkpoint inhibitor resistance and therefore represents a rational strategy to enhance or restore anti-tumor immunity when combined with nivolumab, a checkpoint inhibitor therapy.

Pembrolizumab is a humanized IgG4 monoclonal antibody that binds to the PD-1 receptor and selectively blocks its interaction with PD-L1 and PD-L2, releasing PD-1 pathway-mediated inhibition of the immune response, including the anti-tumor immune response. Enfortumab vedotin (enfortumab) is an investigational ADC that is comprised of a fully human anti-Nectin-4 IgG1 monoclonal antibody conjugated to MMAE via a protease-cleavable linker. Enfortumab binds to cells that express Nectin-4 with high affinity, triggering the internalization and release of MMAE in target cells, inducing cell cycle arrest and apoptotic cell death. Early efficacy results from enfortumab in combination with pembrolizumab in frontline cisplatin-ineligible urothelial carcinoma in the ongoing EV-103 study have demonstrated encouraging activity with a safety profile that appears manageable and tolerable. Addition of sitravatinib to this combination might further augment clinical activity by selectively inhibiting key molecular and cellular pathways strongly implicated in checkpoint inhibitor resistance.

Conditions

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Urothelial Carcinoma Urothelial Carcinoma Bladder Urothelial Carcinoma Ureter Urothelial Carcinoma of the Renal Pelvis and Ureter Urothelial Carcinoma Urethra

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

There are 9 cohorts (having 9-55 maximum patients enrolled in each; based upon response rate). Patients are assigned to cohorts based upon their prior treatments for urothelial carcinoma.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Cohort 1

Patients previously treated with checkpoint inhibitor and platinum-based chemotherapy. Nivolumab over 30 min IV infusion (240 mg IV every 2 weeks or 480 mg every 4 weeks) and sitravatinib 120 mg orally once per day continuously in 28-day cycles.

Group Type EXPERIMENTAL

Sitravatinib

Intervention Type DRUG

Sitravatinib is a small molecule inhibitor of receptor tyrosine kinases

Nivolumab

Intervention Type DRUG

Nivolumab is a programmed death receptor-1 (PD-1) blocking antibody

Cohort 2

Patients previously treated with checkpoint inhibitor, but ineligible for platinum-based chemotherapy. Nivolumab over 30 min IV infusion (240 mg IV every 2 weeks or 480 mg every 4 weeks) and sitravatinib 120 mg orally once per day continuously in 28-day cycles.

Group Type EXPERIMENTAL

Sitravatinib

Intervention Type DRUG

Sitravatinib is a small molecule inhibitor of receptor tyrosine kinases

Nivolumab

Intervention Type DRUG

Nivolumab is a programmed death receptor-1 (PD-1) blocking antibody

Cohort 3

Patients previously treated with selected immunotherapies and platinum-based chemotherapy. Nivolumab over 30 min IV infusion (240 mg IV every 2 weeks or 480 mg every 4 weeks) and sitravatinib 120 mg orally once per day continuously in 28-day cycles.

Group Type EXPERIMENTAL

Sitravatinib

Intervention Type DRUG

Sitravatinib is a small molecule inhibitor of receptor tyrosine kinases

Nivolumab

Intervention Type DRUG

Nivolumab is a programmed death receptor-1 (PD-1) blocking antibody

Cohort 4

Patients previously treated with with selected immunotherapies, but ineligible for platinum-based chemotherapy. Nivolumab over 30 min IV infusion (240 mg IV every 2 weeks or 480 mg every 4 weeks) and sitravatinib 120 mg orally once per day continuously in 28-day cycles.

Group Type EXPERIMENTAL

Sitravatinib

Intervention Type DRUG

Sitravatinib is a small molecule inhibitor of receptor tyrosine kinases

Nivolumab

Intervention Type DRUG

Nivolumab is a programmed death receptor-1 (PD-1) blocking antibody

Cohort 5

Patients previously treated with platinum-based chemotherapy, but never treated with checkpoint inhibitor. Nivolumab over 30 min IV infusion (240 mg IV every 2 weeks or 480 mg every 4 weeks) and sitravatinib 120 mg orally once per day continuously in 28-day cycles.

Group Type EXPERIMENTAL

Sitravatinib

Intervention Type DRUG

Sitravatinib is a small molecule inhibitor of receptor tyrosine kinases

Nivolumab

Intervention Type DRUG

Nivolumab is a programmed death receptor-1 (PD-1) blocking antibody

Cohort 6

Patients ineligible for treatment with platinum-based chemotherapy and never treated with checkpoint inhibitor. Nivolumab over 30 min IV infusion (240 mg IV every 2 weeks or 480 mg every 4 weeks) and sitravatinib 120 mg orally once per day continuously in 28-day cycles.

Group Type EXPERIMENTAL

Sitravatinib

Intervention Type DRUG

Sitravatinib is a small molecule inhibitor of receptor tyrosine kinases

Nivolumab

Intervention Type DRUG

Nivolumab is a programmed death receptor-1 (PD-1) blocking antibody

Cohort 7

Patients previously treated with antibody-drug conjugate, checkpoint inhibitor and platinum-based chemotherapy. Nivolumab over 30 min IV infusion (240 mg IV every 2 weeks or 480 mg every 4 weeks) and sitravatinib 120 mg orally once per day continuously in 28-day cycles.

Group Type EXPERIMENTAL

Sitravatinib

Intervention Type DRUG

Sitravatinib is a small molecule inhibitor of receptor tyrosine kinases

Nivolumab

Intervention Type DRUG

Nivolumab is a programmed death receptor-1 (PD-1) blocking antibody

Cohort 8

Patients previously treated with antibody-drug conjugate and checkpoint inhibitor, but ineligible for platinum-based chemotherapy. Nivolumab over 30 min IV infusion (240 mg IV every 2 weeks or 480 mg every 4 weeks) and sitravatinib 120 mg orally once per day continuously in 28-day cycles.

Group Type EXPERIMENTAL

Sitravatinib

Intervention Type DRUG

Sitravatinib is a small molecule inhibitor of receptor tyrosine kinases

Nivolumab

Intervention Type DRUG

Nivolumab is a programmed death receptor-1 (PD-1) blocking antibody

Cohort 9

Patients previously treated with checkpoint inhibitor and platinum-based chemotherapy. There are 2 parts to this Cohort - a lead-in dose escalation portion and a dose expansion portion. In the dose escalation portion, treatment with up to 3 dose levels of sitravatinib in combination with up to 2 dose levels of pembrolizumab and enfortumab combination regimen to determine the recommended doses to be used in the combination treatment regimen and those doses will be further studied in the dose expansion portion. Pembrolizumab 200 mg over 30 min IV infusion every 3 weeks, sitravatinib orally once per day continuously in 21-day cycles (at 35 mg, 50 mg, 70 mg, or 100 mg) and enfortumab vedotin over 30 min IV infusion on Day 1 and Day 8 in 21-day cycles (at 1 mg/kg or 1.25 mg/kg).

Group Type EXPERIMENTAL

Sitravatinib

Intervention Type DRUG

Sitravatinib is a small molecule inhibitor of receptor tyrosine kinases

Pembrolizumab

Intervention Type DRUG

Pembrolizumab is a programmed death receptor-1 (PD-1) blocking antibody

Enfortumab vedotin

Intervention Type DRUG

Enfortumab is a Nectin-4 directed antibody-drug conjugate (ADC) comprised of a monoclonal antibody conjugated to the small molecule microtubule disrupting agent, monomethyl auristatin E (MMAE)

Interventions

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Sitravatinib

Sitravatinib is a small molecule inhibitor of receptor tyrosine kinases

Intervention Type DRUG

Nivolumab

Nivolumab is a programmed death receptor-1 (PD-1) blocking antibody

Intervention Type DRUG

Pembrolizumab

Pembrolizumab is a programmed death receptor-1 (PD-1) blocking antibody

Intervention Type DRUG

Enfortumab vedotin

Enfortumab is a Nectin-4 directed antibody-drug conjugate (ADC) comprised of a monoclonal antibody conjugated to the small molecule microtubule disrupting agent, monomethyl auristatin E (MMAE)

Intervention Type DRUG

Other Intervention Names

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MGCD516 Opdivo Keytruda Padcev

Eligibility Criteria

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Inclusion Criteria

* Diagnosis of urothelial carcinoma
* Adequate bone marrow and organ function

Exclusion Criteria

* Uncontrolled tumor in the brain
* Unacceptable toxicity with prior checkpoint inhibitor
* Impaired heart function
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Mirati Therapeutics Inc.

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Hirak Der-Torossian, MD

Role: STUDY_DIRECTOR

Mirati Therapeutics Inc.

Locations

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The University of Arizona Cancer Center

Tucson, Arizona, United States

Site Status

University of California Irvine

Irvine, California, United States

Site Status

Rocky Mountain Cancer Centers

Aurora, Colorado, United States

Site Status

Yale School of Medicine

New Haven, Connecticut, United States

Site Status

SCRI - Florida Cancer Specialists- North Region

St. Petersburg, Florida, United States

Site Status

Moffitt Cancer Center

Tampa, Florida, United States

Site Status

SCRI - Florida Cancer Specialists - West Palm Beach

West Palm Beach, Florida, United States

Site Status

The University of Chicago

Chicago, Illinois, United States

Site Status

Indiana University - Melvin & Bren Simon Cancer Center

Indianapolis, Indiana, United States

Site Status

Norton Cancer Institute - Broadway

Louisville, Kentucky, United States

Site Status

Ochsner Cancer Institute

New Orleans, Louisiana, United States

Site Status

Maryland Oncology Hematology, P.A.

Lanham, Maryland, United States

Site Status

Dana Farber Cancer Institute

Boston, Massachusetts, United States

Site Status

Barbara Ann Karmanos Cancer Institute

Detroit, Michigan, United States

Site Status

Washington University School of Medicine - Siteman Cancer Center

St Louis, Missouri, United States

Site Status

GU Research Network/Urology Cancer Center

Omaha, Nebraska, United States

Site Status

Comprehensive Cancer Centers of Nevada - Southwest

Las Vegas, Nevada, United States

Site Status

New York Oncology Hematology - Albany Medical Center

Albany, New York, United States

Site Status

Roswell Park Cancer Institute

Buffalo, New York, United States

Site Status

Northwell Health Monter Cancer Center

Lake Success, New York, United States

Site Status

NYU Langone Laura & Isaac Perlmutter Cancer Center

New York, New York, United States

Site Status

Memorial Sloan-Kettering Cancer Center

New York, New York, United States

Site Status

New York-Presbyterian - Weill Cornell Medical Center

New York, New York, United States

Site Status

University of North Carolina - Lineberger Comprehensive Cancer Center

Chapel Hill, North Carolina, United States

Site Status

Duke University Hospital

Durham, North Carolina, United States

Site Status

The Ohio State University College of Medicine

Columbus, Ohio, United States

Site Status

Allegheny General Hospital

Pittsburgh, Pennsylvania, United States

Site Status

Vanderbilt University - Ingram Cancer Center

Nashville, Tennessee, United States

Site Status

Texas Oncology-Austin Central

Austin, Texas, United States

Site Status

Texas Oncology- Memorial City

Houston, Texas, United States

Site Status

University of Texas - MD Anderson Cancer Center

Houston, Texas, United States

Site Status

University of Texas Health Science Center

San Antonio, Texas, United States

Site Status

Texas Oncology - Tyler

Tyler, Texas, United States

Site Status

Virginia Cancer Specialists- Fairfax

Fairfax, Virginia, United States

Site Status

Virginia Oncology Associates

Norfolk, Virginia, United States

Site Status

Seattle Cancer Center Alliance

Seattle, Washington, United States

Site Status

Countries

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United States

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Other Identifiers

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516-003

Identifier Type: -

Identifier Source: org_study_id

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