Combination Margetuximab, Retifanlimab, Tebotelimab, and Chemotherapy Phase 2/3 Trial in HER2+ Gastric/GEJ Cancer

NCT ID: NCT04082364

Last Updated: 2025-06-08

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

COMPLETED

Clinical Phase

PHASE2/PHASE3

Total Enrollment

82 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-09-30

Study Completion Date

2025-03-25

Brief Summary

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This is a Phase 2/3, randomized, open-label study for the treatment of patients with HER2-positive Gastric cancer (GC) or Gastroesophageal Junction (GEJ) cancer conducted in two parts.

Part A is a single-arm cohort (Cohort A, 40 to 110 participants) will evaluate safety and efficacy of margetuximab plus retifanlimab.

Part B Part 1 has 4 arms (50 patients/arm). Participants will be randomized to margetuximab plus retifanlimab plus chemotherapy, margetuximab plus tebotelimab, plus chemotherapy, margetuximab plus chemotherapy, or trastuzumab plus chemotherapy.

Detailed Description

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Conditions

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Gastric Cancer Gastroesophageal Junction Cancer HER2-positive Gastric Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Cohort A is a single-arm cohort to evaluate safety and efficacy of margetuximab plus retifanlimab. Cohort B Part 1 is a randomized, 4-arm segment to evaluate margetuximab plus retifanlimab plus chemotherapy, margetuximab plus tebotelimab plus chemotherapy, margetuximab plus chemotherapy, vs trastuzumab plus chemotherapy.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Chemotherapy-free arm

margetuximab plus retifanlimab

Group Type EXPERIMENTAL

margetuximab

Intervention Type BIOLOGICAL

margetuximab: Fc-modified anti-HER2 monoclonal antibody: 15 mg/kg IV, Day1 of each 3-week cycle

Retifanlimab

Intervention Type BIOLOGICAL

Retifanlimab: anti-PD-1 checkpoint inhibitor 375 mg IV, Day 1 of each 3-week cycle.

Margetuximab, retifanlimab, and chemotherapy arm

margetuximab plus retifanlimab plus investigator choice of chemotherapy options.

Chemotherapy options: capecitabine and oxaliplatin (XELOX) or modified 5-FU, leucovorin, and oxaliplatin regimen 6 (mFOLFOX-6)

Group Type EXPERIMENTAL

margetuximab

Intervention Type BIOLOGICAL

margetuximab: Fc-modified anti-HER2 monoclonal antibody: 15 mg/kg IV, Day1 of each 3-week cycle

Retifanlimab

Intervention Type BIOLOGICAL

Retifanlimab: anti-PD-1 checkpoint inhibitor 375 mg IV, Day 1 of each 3-week cycle.

Chemotherapy

Intervention Type OTHER

Investigator choice of 1 of 2 chemotherapy regimens: XELOX or mFOLFOX6

Chemotherapy

XELOX chemotherapy Capecitabine: 1000 mg/m2 as oral capsules twice a day Days 1-14 of each cycle, Oxaliplatin: 130 mg/m2 of Day 1 of each 3-week cycle as IV infusion

mFOLFOX6 chemotherapy: Leucovorin: 400 mg/m2 every 2 weeks as IV infusion, 5-FU bolus: 400 mg/m2 every 2 weeks as IV infusion, 5-FU continuous infusion: 2400 mg/m2 every 2 weeks as a 46 hr infusion, Oxaliplatin: 85 mg/m2 every 2 weeks as IV infusion.

Margetuximab, tebotelimab and chemotherapy arm

margetuximab plus tebotelimab plus investigator choice of chemotherapy options. Chemotherapy options: capecitabine and oxaliplatin (XELOX) or modified 5-FU, leucovorin, and oxaliplatin regimen 6 (mFOLFOX-6)

Group Type EXPERIMENTAL

margetuximab

Intervention Type BIOLOGICAL

margetuximab: Fc-modified anti-HER2 monoclonal antibody: 15 mg/kg IV, Day1 of each 3-week cycle

Tebotelimab

Intervention Type BIOLOGICAL

Tebotelimab: anti PD-1, anti-LAG3 bispecific DART (R) molecule 600 mg IV, Day 1 of each 3-week cycle.

Chemotherapy

Intervention Type OTHER

Investigator choice of 1 of 2 chemotherapy regimens: XELOX or mFOLFOX6

Chemotherapy

XELOX chemotherapy Capecitabine: 1000 mg/m2 as oral capsules twice a day Days 1-14 of each cycle, Oxaliplatin: 130 mg/m2 of Day 1 of each 3-week cycle as IV infusion

mFOLFOX6 chemotherapy: Leucovorin: 400 mg/m2 every 2 weeks as IV infusion, 5-FU bolus: 400 mg/m2 every 2 weeks as IV infusion, 5-FU continuous infusion: 2400 mg/m2 every 2 weeks as a 46 hr infusion, Oxaliplatin: 85 mg/m2 every 2 weeks as IV infusion.

Margetuximab and chemotherapy arm

margetuximab plus investigator choice of chemotherapy options. Chemotherapy options: capecitabine and oxaliplatin (XELOX) or modified 5-FU, leucovorin, and oxaliplatin regimen 6 (mFOLFOX-6)

Group Type EXPERIMENTAL

margetuximab

Intervention Type BIOLOGICAL

margetuximab: Fc-modified anti-HER2 monoclonal antibody: 15 mg/kg IV, Day1 of each 3-week cycle

Chemotherapy

Intervention Type OTHER

Investigator choice of 1 of 2 chemotherapy regimens: XELOX or mFOLFOX6

Chemotherapy

XELOX chemotherapy Capecitabine: 1000 mg/m2 as oral capsules twice a day Days 1-14 of each cycle, Oxaliplatin: 130 mg/m2 of Day 1 of each 3-week cycle as IV infusion

mFOLFOX6 chemotherapy: Leucovorin: 400 mg/m2 every 2 weeks as IV infusion, 5-FU bolus: 400 mg/m2 every 2 weeks as IV infusion, 5-FU continuous infusion: 2400 mg/m2 every 2 weeks as a 46 hr infusion, Oxaliplatin: 85 mg/m2 every 2 weeks as IV infusion.

Trastuzumab and chemotherapy arm

Trastuzumab plus investigator choice of chemotherapy options. Chemotherapy options: capecitabine and oxaliplatin (XELOX) or modified 5-FU, leucovorin, and oxaliplatin regimen 6 (mFOLFOX-6)

Group Type ACTIVE_COMPARATOR

Trastuzumab

Intervention Type BIOLOGICAL

Anti-HER2 monoclonal antibody 8 mg/kg loading dose and then 6 mg/kg administered IV on Day 1 of each 3-week cycle

Chemotherapy

Intervention Type OTHER

Investigator choice of 1 of 2 chemotherapy regimens: XELOX or mFOLFOX6

Chemotherapy

XELOX chemotherapy Capecitabine: 1000 mg/m2 as oral capsules twice a day Days 1-14 of each cycle, Oxaliplatin: 130 mg/m2 of Day 1 of each 3-week cycle as IV infusion

mFOLFOX6 chemotherapy: Leucovorin: 400 mg/m2 every 2 weeks as IV infusion, 5-FU bolus: 400 mg/m2 every 2 weeks as IV infusion, 5-FU continuous infusion: 2400 mg/m2 every 2 weeks as a 46 hr infusion, Oxaliplatin: 85 mg/m2 every 2 weeks as IV infusion.

Interventions

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margetuximab

margetuximab: Fc-modified anti-HER2 monoclonal antibody: 15 mg/kg IV, Day1 of each 3-week cycle

Intervention Type BIOLOGICAL

Retifanlimab

Retifanlimab: anti-PD-1 checkpoint inhibitor 375 mg IV, Day 1 of each 3-week cycle.

Intervention Type BIOLOGICAL

Tebotelimab

Tebotelimab: anti PD-1, anti-LAG3 bispecific DART (R) molecule 600 mg IV, Day 1 of each 3-week cycle.

Intervention Type BIOLOGICAL

Trastuzumab

Anti-HER2 monoclonal antibody 8 mg/kg loading dose and then 6 mg/kg administered IV on Day 1 of each 3-week cycle

Intervention Type BIOLOGICAL

Chemotherapy

Investigator choice of 1 of 2 chemotherapy regimens: XELOX or mFOLFOX6

Chemotherapy

XELOX chemotherapy Capecitabine: 1000 mg/m2 as oral capsules twice a day Days 1-14 of each cycle, Oxaliplatin: 130 mg/m2 of Day 1 of each 3-week cycle as IV infusion

mFOLFOX6 chemotherapy: Leucovorin: 400 mg/m2 every 2 weeks as IV infusion, 5-FU bolus: 400 mg/m2 every 2 weeks as IV infusion, 5-FU continuous infusion: 2400 mg/m2 every 2 weeks as a 46 hr infusion, Oxaliplatin: 85 mg/m2 every 2 weeks as IV infusion.

Intervention Type OTHER

Other Intervention Names

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MGAH22 Margenza® MGA012 INCMGA00012 MGD013 Herceptin

Eligibility Criteria

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Inclusion Criteria

* Histologically confirmed diagnosis of previously untreated locally advanced unresectable or metastatic HER2+ GC or GEJ adenocarcinoma

1. Prior systemic perioperative treatment is allowed; however the participants must have had a disease-free interval of at least 6 months from end of chemo/surgery
2. Participants receiving perioperative anti-HER2 therapy require testing of HER2 status for eligibility
3. Cohort A: HER2-positive (by IHC 3+) and PD-L1-positive (by IHC with 22C3 CPS ≥ 1%) per central review
4. Cohort B: HER2-positive (by IHC 3+ or IHC 2+ in combination with FISH+) by local review. PD -L1 status is not required for enrollment.
* Availability of formalin-fixed, paraffin-embedded tumor specimen, unstained slides or contemporaneous biopsy for tumor target testing
* Eastern Cooperative Oncology Group performance status of 0 or 1, verified within 3 days of Day 1
* Life expectancy ≥ 6 months
* At least one radiographically measurable target lesion
* Acceptable laboratory parameters and adequate organ function

Exclusion Criteria

* Other malignancy that is progressing or required treatment within the past 5 years, with certain exceptions

* Participants with known MSI-H status
* History of allogeneic stem cell or tissue/solid organ transplant
* Central nervous system metastases
* Clinically significant cardiovascular disease, gastrointestinal disorders, pulmonary compromise

* Prior neoadjuvant or adjuvant treatment with immunotherapy
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Zai Lab (Shanghai) Co., Ltd.

INDUSTRY

Sponsor Role collaborator

MacroGenics

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Stephen L. Eck, MD, PhD

Role: STUDY_DIRECTOR

MacroGenics

Locations

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Mayo Clinic - Scottsdale

Scottsdale, Arizona, United States

Site Status

City of Hope Comprehensive Cancer Center - Duarte

Duarte, California, United States

Site Status

Norris Comprehensive Cancer Center (USC)

Los Angeles, California, United States

Site Status

Salinas Memorial

Salinas, California, United States

Site Status

UCLA School of Medicine

Santa Monica, California, United States

Site Status

Yale University

New Haven, Connecticut, United States

Site Status

Florida Cancer Specialists South

Fort Myers, Florida, United States

Site Status

Mayo Clinic - Jacksonville

Jacksonville, Florida, United States

Site Status

Ocala Oncology Center PL DBA Florida Cancer Affiliates - Ocala

Ocala, Florida, United States

Site Status

Florida Cancer Specialists North

St. Petersburg, Florida, United States

Site Status

Kaiser Permanente

Honolulu, Hawaii, United States

Site Status

University of Chicago

Chicago, Illinois, United States

Site Status

Edward H. Kaplan MD & Associates

Skokie, Illinois, United States

Site Status

Massachusetts General Hospital Cancer Center

Boston, Massachusetts, United States

Site Status

Henry Ford Health System

Detroit, Michigan, United States

Site Status

Cancer & Hematology Centers of Western Michigan - Lemmen-Holton Cancer Pavilion

Grand Rapids, Michigan, United States

Site Status

Mayo Clinic - Rochester

Rochester, Minnesota, United States

Site Status

Washington University School of Medicine

St Louis, Missouri, United States

Site Status

Nebraska Heme Onc

Lincoln, Nebraska, United States

Site Status

Rutgers Cancer Institute of New Jersey

New Brunswick, New Jersey, United States

Site Status

The University of New Mexico Comprehensive Cancer Center

Albuquerque, New Mexico, United States

Site Status

Stephenson Cancer Center at OUHSC

Oklahoma City, Oklahoma, United States

Site Status

Sarah Cannon Research Institute

Nashville, Tennessee, United States

Site Status

Oncology Consultants

Houston, Texas, United States

Site Status

Utah Cancer Specialists

Salt Lake City, Utah, United States

Site Status

Virginia Cancer Specialists

Fairfax, Virginia, United States

Site Status

Swedish Cancer Institute

Seattle, Washington, United States

Site Status

University of Wisconsin

Madison, Wisconsin, United States

Site Status

Beijing Cancer Hospital

Beijing, , China

Site Status

Jilin Cancer Hospital (Second People's Hospital Of Jilin Province)

Changchun, , China

Site Status

Fujian Medical University - Fujian Provincial Cancer Hospital (Fujian Provincial Tumor Hospital)

Fuzhou, , China

Site Status

SIR RUN RUN SHAW Hospital, Zhejiang University school of medicine

Hangzhou, , China

Site Status

Zhejiang Cancer Hospital

Hangzhou, , China

Site Status

Affiliated Tumor Hospital of Harbin Medical University- the 3rd Affiliated Hospital of Harbin

Harbin, , China

Site Status

The First Affiliated Hospital of Anhui Medical University

Hefei, , China

Site Status

Anhui Provincial Cancer Hospital

Hefei, , China

Site Status

Jinan Center Hospital

Jinan, , China

Site Status

Nanjing University Medical School; Nanjing Drug Tower

Nanjing, , China

Site Status

Zhongshan Hospital Fudan University

Shanghai, , China

Site Status

Liaoning cancer hospital

Shenyang, , China

Site Status

Hebei cancer hospital (The Fourth Affiliate)

Shijiazhuang, , China

Site Status

Wuhan Union Hospital

Wuhan, , China

Site Status

Henan Cancer Hospital

Zhengzhou, , China

Site Status

The First Affiliated Hospital of Zhengzhou University

Zhenzhou, , China

Site Status

Institute of Clinical Cancer Research Krankenhaus Nordwest (IKF)

Frankfurt, , Germany

Site Status

Haematologisch-Onkologische Praxis Eppendorf

Hamburg, , Germany

Site Status

Universitätsmedizin Mainz

Mainz, , Germany

Site Status

Kliniken Maria Hilf GmbH

Mönchengladbach, , Germany

Site Status

Ospedale San Raffaele

Milan, , Italy

Site Status

Istituto Europeo Di Oncologia

Milan, , Italy

Site Status

Azienda Ospedaliero-Universitaria Pisana

Pisa, , Italy

Site Status

SPSK nr 1 in Lublin

Lublin, , Poland

Site Status

Centrum Medyczne MrukMed

Rzeszów, , Poland

Site Status

National University Hospital (Cancer Institute) -Singapore

Singapore, , Singapore

Site Status

National Cancer Center Singapore

Singapore, , Singapore

Site Status

Hallym University Sacred Heart Hospital

Anyang-si, , South Korea

Site Status

CHA bundang

Gyeonggi-do, , South Korea

Site Status

Inje University Haeundae Paik Hospital

Haeundae, , South Korea

Site Status

Seoul National University Bundang Hospital

Seongnam-si, , South Korea

Site Status

Asan Medical Center

Seoul, , South Korea

Site Status

Korea University Guro

Seoul, , South Korea

Site Status

Korea University, Anam Hospital

Seoul, , South Korea

Site Status

Samsung Medical Center

Seoul, , South Korea

Site Status

Seoul National University Hospital

Seoul, , South Korea

Site Status

Yonsei University College of Medicine (Severance Hospital)

Seoul, , South Korea

Site Status

Catholic University of Korea St. Vincent Hospital

Suwon, , South Korea

Site Status

Taipei Medical University Hospital

Taipei City, Taipei, Taiwan

Site Status

Kaohsiung Chang Gung MemorialHospital

Kaohsiung City, , Taiwan

Site Status

Chang Gung Memorial Hospital, Keelung

Keelung, , Taiwan

Site Status

Liuying Chi MeiMedical Hospital

Tainan City, , Taiwan

Site Status

National Taiwan University

Taipei, , Taiwan

Site Status

Cambridge University Hospitals NHS Foundation Trust Addenbrooke's Hospital

Cambridge, , United Kingdom

Site Status

The Christie Hospital NHS Foundation Trust

Manchester, , United Kingdom

Site Status

Countries

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United States China Germany Italy Poland Singapore South Korea Taiwan United Kingdom

References

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Catenacci DV, Rosales M, Chung HC, H Yoon H, Shen L, Moehler M, Kang YK. MAHOGANY: margetuximab combination in HER2+ unresectable/metastatic gastric/gastroesophageal junction adenocarcinoma. Future Oncol. 2021 Apr;17(10):1155-1164. doi: 10.2217/fon-2020-1007. Epub 2020 Dec 2.

Reference Type DERIVED
PMID: 33263418 (View on PubMed)

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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CP-MGAH22-06

Identifier Type: -

Identifier Source: org_study_id

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