Rintatolimod and IFN Alpha-2b for the Treatment of COVID-19 in Cancer Patients

Study Results

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE1/PHASE2

Total Enrollment

4 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-11-17

Study Completion Date

2023-03-15

Brief Summary

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This phase I/IIa trial studies the best dose and side effects of rintatolimod and interferon (IFN) alpha-2b in treating cancer patients with COVID-19 infection. Interferon alpha is a protein important for defense against viruses. It activates immune responses that help to clear viral infection. Rintatolimod is double stranded ribonucleic acid (RNA) designed to mimic viral infection by stimulating immune pathways that are normally activated during viral infection. Giving rintatolimod and interferon alpha-2b may activate the immune system to limit the replication and spread of the virus.

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Detailed Description

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PRIMARY OBJECTIVES:

I. To determine the safety of the combination of intravenous (i.v.) rintatolimod administered with or without i.v. IFN alpha (recombinant interferon alfa-2b \[Intron A\]) in patients with cancer with coronavirus disease 2019 (COVID-19).

II. Determine the kinetics of viral load in nasopharyngeal swabs in the course of treatment and Days 7 and 14.

SECONDARY OBJECTIVES:

I. To assess the efficacy of the treatment combination in patients with cancer with COVID-19.

II. Determine the kinetics of viral load in the peripheral blood in the course of treatment and Days 7 and 14.

III. Determine the kinetics of changes of the immune subsets and circulating inflammatory mediators (including C-reactive protein \[CRP\], cytokines, chemokines, interferons) in peripheral blood in the course of treatment and Days 7 and 14.

IV. Determine the induction of known mediators of antiviral immunity that include (myxovirus resistance gene, MxA; protein Kinase R (PKR); oligoadenylate synthetase-2 (OAS2); RNAse-L, IFN-stimulated gene-15 (ISG15); IFN-induced proteins with tetratricopeptide repeats (IFIT1) and IFN-inducible transmembrane protein 3 (IFITM3), TLR3, RIG-I, MDA5, IRF3, IRF7, in nasopharyngeal swabs material and blood cells of patients on all tiers of treatment.

OUTLINE: This is a phase I, dose-escalation study of recombinant interferon alfa-2b followed by a phase II study.

LEAD-IN PHASE: Patients receive rintatolimod IV over 2.5-3 hours on day 1 and day 3 (or 4).

ARM I: Patients receive rintatolimod IV over 2.5-3 hours and recombinant interferon alfa-2b IV over 20 minutes on day 1 and on day 3 or 4 in the absence of disease progression or unacceptable toxicity.

EXPANSION COHORT:

ARM III: Patients receive rintatolimod IV over 2.5-3 hours along with standard of care.

Patients are followed up at days 7, 14 and 30 after initiation of the study regimen.

Conditions

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Hematopoietic and Lymphoid Cell Neoplasm Malignant Solid Neoplasm Symptomatic COVID-19 Infection Laboratory-Confirmed

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

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Recombinant Interferon Alfa-2b

Given IV

Intervention Type BIOLOGICAL

Rintatolimod

Given IV

Intervention Type DRUG

Other Intervention Names

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Alfatronol Glucoferon Heberon Alfa IFN alpha-2B Interferon alfa 2b Interferon Alfa-2B Interferon Alpha-2b Intron A Sch 30500 Urifron Viraferon Ampligen Atvogen

Eligibility Criteria

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Inclusion Criteria

* Patients with cancer, with the exception of patients with active acute leukemia and allogeneic hematopoietic stem cell transplant recipients. Patients may be on active therapy or received therapy (e.g., chemotherapy, radiation or surgery) within 7 years. Patients with active cancer who have not yet been treated (e.g. newly diagnosed cancer or early stage myelodysplastic syndrome \[MDS\] or chronic lymphocytic leukemia \[CLL\]) are eligible. Basal cell cancer and carcinoma in situ treated with local excision alone do not qualify for inclusion
* Presence of symptomatic infection, defined by fever (temperature \[T\] \>= 38 degrees Celsius \[C\]) OR respiratory symptoms (cough, nasal congestion, or shortness of breath) OR lung infilitrates on chest X-ray or CT imaging. Diagnosis of COVID-19 is based on polymerase chain reaction (PCR) testing of respiratory samples.
* Age equal to \>= 18 years or older (children are excluded because COVID-19 typically has a milder course in children, and lack of safety data of this regimen in children)
* Platelet \>= 75,000/uL
* Hemoglobin \>= 9 g/dL
* Hematocrit \>= 27%
* Absolute neutrophil count (ANC) \>= 1000/uL
* Creatinine clearance \>= 50 mL/min (Cockcroft-Gault Equation-note: plasma creatine instead of serum is used at Roswell Park)
* Total bilirubin =\< 2 X institutional upper limit of normal (ULN)
* Aspartate transaminase (AST) (plasma) and alanine transferase (ALT) (plasma) =\< 2 X institutional ULN
* Plasma amylase and lipase =\< 2 X institutional ULN
* In the absence of COVID-19, a life expectancy of 6 months is expected
* Participant must understand the investigational nature of this study and sign an Independent Ethics Committee/Institutional Review Board approved written informed consent form prior to receiving any study related procedure
* NOTE: For blood chemistry labs, Roswell Park clinical blood chemistries are performed on plasma unless otherwise indicated
* EXPANSION COHORT: Patients with cancer or allogeneic stem cell transplant recipients with and without a cancer diagnosis

* Patients with cancer may be on active therapy or received therapy (e.g., chemotherapy, radiation or surgery) within 7 years
* Patients with active cancer who have not yet been treated (e.g. newly diagnosed cancer or early stage MDS or CLL) are eligible
* Basal cell cancer and carcinoma in situ treated with local excision alone do not qualify for inclusion
* Presence of symptomatic infection, defined by fever (T \>= 38.0 degrees C ) OR respiratory symptoms (cough, nasal congestion, or shortness of breath) OR lung infiltrates by chest X-ray or CT imaging. Diagnosis of COVID-19 is based on PCR testing of respiratory samples. Severe infection is excluded
* Age equal to \>= 18 years or older (children are excluded because COVID-19 typically has a milder course in children, and lack of safety data of this regimen in children). In the absence of COVID-19, a life expectancy of 6 months is expected
* Participant must understand the investigational nature of this study and sign an Independent Ethics Committee/Institutional Review Board approved written informed consent form prior to receiving any study related procedure. There may be specific instances when the patient can't provide informed consent, e.g. they require mechanical ventilation and are sedated, in which case a health care proxy will be able to provide informed consent. Patients with temporary cognitive impairment will be consented once their capacity has returned. Patients with chronic cognitive impairment, e.g. dementia, that precludes informed consent will not be enrolled.

Exclusion Criteria

* Patients with severe COVID-19 infection defined by pulmonary infiltrates on chest x-ray or computed tomography (CT) imaging plus one of the following: room air oxygen saturation (SaO2) =\< 92%, room air partial pressure of oxygen (PaO2) \< 70 mm Hg, or partial pressure of oxygen in arterial blood (PaO2)-PaO2 (alveolar gas) \>= 35 mm Hg
* Contraindication to recombinant (r)-INFalpha based on prior hypersensitivity, autoimmune hepatitis, decompensated liver disease
* Cardiac events:

* Acute coronary syndrome, myocardial infarction, or ischemia within past 3 months
* New York Heart Association classification of III or IV congestive heart failure
* Unwilling or unable to follow protocol requirements
* Patients with known serious mood disorders
* Any additional condition, such as pre-existing inflammatory lung disease, which in the investigator's opinion deems the participant an unsuitable candidate to receive the study drugs
* Concurrent infections, e.g. bacterial pneumonia or sepsis, that would make it difficult to evaluate clinical response to therapy or study drug toxicities
* Therapies known to cause cytokine release syndrome (CRS), e.g. engineered T cells, within 30 days
* Patients at high risk for tumor lysis syndrome
* Concurrent active pneumonitis predating COVID-19, such as from checkpoint inhibitor therapy, chemotherapy-associated toxicity, or radiation pneumonitis
* Autoimmune disease that requires systemic immunosuppression
* Protocol-defined baseline abnormalities in cell counts, renal, or hepatic function
* Any additional condition which in the investigator's opinion deems the participant an unsuitable candidate to receive the study drugs
* Patients with respiratory failure requiring mechanical ventilation with FIO2 of \> 60%.
* Allogeneic hematopoietic stem cell transplant recipients with active pulmonary graft versus host disease (GvHD) (any grade)
* Cardiac events:

* Acute coronary syndrome, myocardial infarction, or ischemia within past 3 months,
* New York Heart Association classification of III or IV congestive heart failure
* Unwilling or unable to follow protocol requirements
* Any additional condition which in the investigator's opinion deems the participant an unsuitable candidate to receive the study drugs
* Cognitively impaired adults/adults with impaired decision-making capacity
* Individuals who are not yet adults (infants, children, teenagers)
* Pregnant women
* Prisoners

Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No