APX005M With Concurrent Chemoradiation for Resectable Esophageal and Gastroesophageal Junction Cancers
This pilot phase II trial studies the side effects of CD40 agonistic monoclonal antibody APX005M (APX005M), chemotherapy, and radiation therapy, and to see how well they work when given before surgery in treating patients with esophageal cancer or gastroesophageal cancer that can be removed by surgery. APX005M is intended to stimulate the body's own immune system so that the immune cells can more effectively invade and destroy the tumor, adding to the benefits of the chemotherapy and radiation therapy. Drugs used in chemotherapy, such as carboplatin and paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Radiation therapy uses high energy x-rays to kill tumor cells and shrink tumors. Giving APX005M, chemotherapy, and radiation therapy before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed.
A Phase 2 Study of APX005M in Combination With Concurrent Chemoradiation as Neoadjuvant Therapy for Resectable Esophageal and Gastroesophageal Junction Cancers
PRIMARY OBJECTIVES: I. To establish the safety and feasibility of combining APX005M with standard-of-care chemoradiation (external beam radiation in daily fractions, with concurrent weekly low-dose carboplatin/paclitaxel) in the neoadjuvant setting for patients with resectable esophageal and gastroesophageal junction (GEJ) cancers. SECONDARY OBJECTIVES: I. To assess the efficacy of this novel combination, as measured by the pathologic complete response (pCR) rate. OUTLINE: Patients receive APX005M intravenously (IV) over 60 minutes during weeks 1, 4, and 7, radiation therapy once daily (QD) for 5 days per week during weeks 3-8, and paclitaxel IV over 60 minutes and carboplatin IV over 60 minutes once weekly (days 1, 8, 15, 22, and 29) during weeks 3-8 in the absence of disease progression or unacceptable toxicity. Patients then undergo surgery 4 - 10 weeks after last dose of APX005M. After completion of study treatment, patients are followed up at 1, 3, and 6 months.
Esophageal Cancer GastroEsophageal Cancer esophagus gastroesophageal (GE) junction T1-3N0-1 Paclitaxel Carboplatin APX005M Radiation Therapy Surgical resection of tumor
You can join if…
Open to people ages 18 years and up
- Age ≥ 18 years of age
- Histologically proven squamous cell carcinoma, adenocarcinoma or undifferentiated carcinoma of the esophagus or GE junction.
- Surgically resectable (T1-3 Nx by endoscopic ultrasound). Excluded are:
- Very early stage tumors (T1N0)
- Cervical esophageal tumors
- Tumors invading the tracheobronchial tree or associated with tracheoesophageal fistula
- Any evidence of distant metastases (as determined by endoscopic ultrasound (EUS) or CT/PET)
- Cervical, supraclavicular, or other nodal disease that is either not included in the radiation field or is not able to be resected at the time of esophagectomy
- Eastern Cooperative Oncology Group (ECOG) performance status 0-1
- Adequate hematological, renal, and hepatic parameters defined as follows:
- Absolute Neutrophil Count (ANC) ≥1.5 × 109/L in absence of growth factor support
- Platelet count ≥150 × 109/L
- Hemoglobin >9 g/dL
- Serum creatinine ≤1.5 mg/dL, or calculated (using the formula of Cockcroft and Gault) or measured creatinine clearance ≥30 mL/min
- Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤2.5 x upper limit of normal (ULN)
- Total bilirubin ≤1.5x ULN
- Women of child bearing potential (WOCBP) must have a negative serum pregnancy test within the 7 days prior to investigational product administration and a negative urine pregnancy test within the 3 days prior to the first investigational product administration, or a negative serum pregnancy test within the 3 days prior to the first investigational product administration
- WOCBP and male subjects who are sexually active with WOCBP must agree to use 2 highly effective methods of contraception (including a physical barrier) during the study and for 30 days following the last dose of investigational product
- Ability to understand a written informed consent document, and the willingness to sign it
You CAN'T join if...
- Any history of or current hematologic malignancy
- History of a second primary cancer is allowed in the event the cancer is curatively resected and there is no evidence of recurrence/metastatic disease x 1 year. Subjects who have a history of cervical or breast carcinoma in situ, localized prostate cancer, adequately treated basal cell or squamous cell carcinoma of the skin, or superficial bladder tumors [Ta, Tis & T1] are also allowed
- Major surgery within 4 weeks of first dose of investigational product
- Prior or concurrent treatment with any anticancer agent for the same cancer diagnosis
- Prior exposure to any immuno-oncology agents, including CD40/PD-1/PD-L1/CTLA-4 inhibitors (if any ambiguity, should be discussed with study principal investigator)
- History of bone marrow transplantation
- Uncontrolled diabetes or hypertension
- History of autoimmune disorders with the exception of vitiligo or autoimmune thyroid disorders
- Chronic steroid dependency (prednisone equivalent > 10 mg/day). Any steroid use should be discontinued at least 2 weeks prior to initiation of study treatment.
- . History of sensitivity or allergy to monoclonal antibodies (mAbs) or immunoglobulin G (IgG)
- . History of severe hypersensitivity reaction to Cremophor EL.
- . Pre-existing > grade 2 peripheral sensory neuropathy.
- . Congestive heart failure (New York Heart Association Class III to IV), symptomatic ischemia, conduction abnormalities uncontrolled by conventional intervention, or myocardial infarction within 6 months before first dose
- . History of any arterial thromboembolic event within 3 months prior to first dose of investigational product
- . Active coagulopathy
- . Active known clinically serious infections (> Grade 2 National Cancer Institute (NCI)-CTCAE version 4.03)
- . Known human immunodeficiency virus (HIV) infection
- . Subjects of reproductive potential who do not use effective methods of birth control
- . Pregnant or actively breastfeeding women
- . Any clinically significant psychiatric, social, or medical condition that, in the opinion of the Investigator, could increase subject's risk, interfere with protocol adherence, or affect a subject's ability to give informed consent.
- University of California, San Francisco
accepting new patients
San Francisco California 94143 United States
- City of Hope Comprehensive Cancer Center
accepting new patients
Duarte California 91010 United States
Lead Scientist at UCSF
- Andrew Ko
Professor, Medicine. Authored (or co-authored) 118 research publications.
- accepting new patients
- Start Date
- Completion Date
- Apexigen, Inc.
- Phase 2
- Study Type
- Last Updated
Please contact me about this study
We will not share your information with anyone other than the team in charge of this study. Submitting your contact information does not obligate you to participate in research.
The study team should get back to you in a few business days.
You will also receive an email with next steps. Check your junk/spam folder if needed.
If you do not hear from the study team, please call 888-689-8273 and tell them you’re interested in study number NCT03165994.