Combining calaspargase pegol-mnkl and cobimetinib for advanced pancreatic cancer treatment

A Phase I, Open-Label, Dose Finding Study of Calaspargase Pegol-Mnkl in Combination With Cobimetinib in Locally-Advanced or Metastatic Pancreatic Cancer

This study is testing a new combination of two drugs to see if they can help people with advanced pancreatic cancer by targeting the cancer cells in a new way.

Quick facts

• Phase: Phase 1
• Study type: Interventional
• Enrollment: 15 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: OHSU Knight Cancer Institute (Academic / other)
• Drugs / interventions: cobimetinib, chemotherapy, immunotherapy
• Locations: 1 site (Portland, Oregon)
• Trial ID: NCT05034627 on ClinicalTrials.gov

What this trial studies

This phase I trial evaluates the safety and optimal dosage of calaspargase pegol-mnkl in conjunction with cobimetinib for patients with locally advanced or metastatic pancreatic cancer. The study aims to deplete the amino acid L-asparagine, which many cancer cells rely on, while also inhibiting the MEK protein that promotes cancer cell growth. Participants will receive intravenous calaspargase pegol-mnkl and oral cobimetinib over a series of treatment cycles, with monitoring of treatment response and safety throughout the study. The trial includes biopsies to assess tumor changes and will follow patients for several months post-treatment.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18 and older with histologically confirmed locally advanced or metastatic pancreatic adenocarcinoma who have progressed on or are intolerant to standard systemic therapies.

Not a fit: Patients who have not received any prior systemic therapy or investigational agents may not benefit from this study.

Why it matters

Potential benefit: If successful, this treatment combination could improve disease control and outcomes for patients with advanced pancreatic cancer.

How similar studies have performed: While this approach is novel, similar studies targeting MEK and amino acid depletion have shown promise in other cancer types.

Eligibility criteria

Inclusion Criteria:

* Participant must provide written informed consent before any study-specific procedures or interventions are performed
* Participants are \>= 18 years old at the time of informed consent. Both men and women of all races and ethnic groups will be included
* Eastern Cooperative Oncology Group (ECOG) performance status of 0-2
* Histologically or cytologically-proven adenocarcinoma of the exocrine pancreas with locally advanced or metastatic disease
* Must have measurable disease as defined by Response Evaluation Criteria in Solid Tumors (RECIST) version (v)1.1
* Must have at least one disease lesion that is amenable to biopsy procedures performed per institutional standards
* Must have progressed on, been intolerant to, or refused systemic therapy that is consistent with institutional standards (e.g., Gemcitabine-based, or fluorouracil, irinotecan, leucovorin and oxaliplatin \[FOLFORINOX\])
* Must not have received any systemic therapy or other investigational agents within 30 days or 5 half-lives (whichever is longer) from first dose of study therapy

  * This requirement is waived for patients receiving cobimetinib or other investigational agent(s) as part of participation in NCT04005690, provided that all prior drug-related toxicities have resolved to Grade ≤ 1 prior to initiating study intervention
* Hemoglobin: \>= 9.0 g/dL with no blood transfusion within 14 days of starting treatment
* White blood cells (WBC): \> 3 x 10\^9/L
* Absolute neutrophil count (ANC): \>= 1.5 x 10\^9/L (\> 1500 per mm\^3)
* Platelet count: \>= 100 x 10\^9/L (\> 100,000 per mm\^3)
* Creatinine =\< 1.5 x upper limit of normal (ULN), or measured or calculated creatinine clearance \>= 60 mL/min/1.73 m\^2 for participants with creatinine levels \> 1 x institutional (ULN)
* Serum bilirubin: =\< 1.5 x institutional ULN
* Aspartate aminotransferase (AST)/alanine aminotransferase (ALT): =\< 2.5 x ULN
* Participants of childbearing potential (POCBP) must agree to abstain from sexual intercourse or use effective non-hormonal methods of contraception starting with the first dose of study therapy through 90 days after the last dose of study therapy (because calaspargase pegol can render hormonal contraceptives ineffective)
* POCBP may participate provided they have a negative serum pregnancy test at screening and a negative serum OR urine pregnancy test within 7 days of starting treatment

Exclusion Criteria:

* Concomitant use of other anti-cancer therapy (chemotherapy, immunotherapy, hormonal therapy (hormone replacement therapy is acceptable), radiotherapy (except for palliative), biological therapy or other novel agent) or live virus and live bacterial vaccines while receiving study medication
* Prior treatment with an L-asparaginase therapy
* Known severe hypersensitivity to calaspargase pegol-mknl (or equivalent) or to cobimetinib (or equivalent), or to any excipient of these medicinal products, or history of allergic reactions attributed to compounds of similar chemical or biologic composition to calaspargase pego-mknl or cobimetinib
* Use of known strong CYP3A inhibitors (e.g., itraconazole, telithromycin, clarithromycin, protease inhibitors boosted with ritonavir or cobicistat, indinavir, saquinavir, nelfinavir, boceprevir, telaprevir), known strong CYP3A inducers (e.g., phenobarbital, enzalutamide, phenytoin, rifampicin, rifabutin, rifapentine, carbamazepine, nevirapine and St John's Wort) or moderate CYP3A inducers (e.g., bosentan, efavirenz, modafinil) within 7 days of prior to initiating study treatment or on going requirement for these medications
* Uncontrolled serious thrombosis
* Uncontrolled severe or symptomatic coagulopathy; exclude if:

  * Prothrombin time (PT) \>= 1.5 x ULN, or
  * International normalized ratio (INR) \>= 1.5 x ULN, or
  * Fibrinogen =\< 0.66 x LLN
* Known history of chronic pancreatitis or recurrent acute pancreatitis, or at time of screening evidence of acute pancreatitis, defined by at least two of the following:

  * Clinical symptoms of upper abdominal pain
  * Serum amylase or lipase that is \>= 3 x ULN
  * Imaging evidence (computed tomography \[CT\], magnetic resonance imaging \[MRI\], ultrasonography)
* Significant cardiac disease within 6 months prior to start of study treatment, including any of the following:

  * New York Heart Association class III or IV,
  * Congestive heart failure, acute coronary syndrome, and/or stroke, or
  * Left ventricular ejection fraction (LVEF) \< 40% by echocardiogram (ECHO) or multigated acquisition (MUGA) scan obtained within 28 days prior to start of study treatment
* Known risk factors for ocular toxicity, consisting of any of the following:

  * History of serous retinopathy
  * History of retinal vein occlusion (RVO)
  * Evidence of ongoing serous retinopathy or RVO at screening
* Uncontrolled hypertension, or hypertension that cannot otherwise be clinically managed before initiating study therapy
* Participant is known to have dysphagia, short-gut syndrome, gastroparesis, or other conditions that limit the ingestion or gastrointestinal absorption of drugs administered orally
* Participant has active uncontrolled systemic fungal, bacterial, or viral infection (defined as ongoing signs/symptoms related to the infection without improvement despite appropriate antibiotics, antiviral therapy, and/or other treatment)
* Participant has corrected QT (QTc) interval (i.e., Fridericia's correction \[QTcF\]) \>= 450 ms or other factors that increase the risk of QT prolongation or arrhythmic events (e.g., heart failure, hypokalemia, family history of long QT interval syndrome) at screening
* Psychiatric illness/social situations that would limit compliance with study requirements
* Any concurrent severe and/or uncontrolled medical condition (e.g. uncontrolled diabetes, infection, hypertension, etc.)
* Participant is pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial, starting with the screening visit through 90 days after the last dose of trial treatment
* Judgment by the investigator that the patient should not participate in the study if the patient is unlikely to comply with study procedures, restrictions and requirements

Where this trial is running

Portland, Oregon

• OHSU Knight Cancer Institute — Portland, Oregon, United States (Recruiting)

Study contacts

• Principal investigator: Charles D Lopez — OHSU Knight Cancer Institute

Conditions Locally Advanced Pancreatic Adenocarcinoma; Metastatic Pancreatic Adenocarcinoma; Stage II Pancreatic Cancer AJCC v8; Stage IIA Pancreatic Cancer AJCC v8; Stage IIB Pancreatic Cancer AJCC v8; Stage III Pancreatic Cancer AJCC v8; Stage IV Pancreatic Cancer AJCC v8