Evaluating TT-10 and TT-4 for advanced solid tumors

Phase I/II First-in-Human Study of TT-10 (PORT-6), an Adenosine 2A Receptor Antagonist, and PORT-7, an Adenosine 2B Receptor Antagonist, as Single Agents and in Combination in Participants With Advanced Selected Solid Tumors

This study is testing two new drugs, TT-10 and TT-4, to see if they are safe and effective for people with advanced solid tumors who haven't had success with other treatments.

Quick facts

• Phase: Phase1; Phase2
• Study type: Interventional
• Enrollment: 90 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Portage Biotech (Industry-sponsored)
• Drugs / interventions: adalimumab, infliximab, vedolizumab, dupilumab, rituximab, tofacitinib, chemotherapy, radiation, methotrexate, prednisone
• Locations: 3 sites (Los Angeles, California and 2 other locations)
• Trial ID: NCT04969315 on ClinicalTrials.gov

What this trial studies

This clinical trial aims to assess the safety, tolerability, and efficacy of two investigational drugs, TT-10 and TT-4, both individually and in combination, in patients with advanced solid tumors who have either failed standard treatments or are not eligible for them. The study is structured in two phases, with the first phase focusing on determining the maximum tolerated dose and the second phase evaluating preliminary efficacy. Participants will be grouped based on their specific cancer types, including renal cell cancer, castrate-resistant prostate cancer, and others. The trial is multicenter and open-label, allowing for a diverse patient population.

Who should consider this trial

Good fit: Ideal candidates include adults aged 18 and older with advanced solid tumors like renal cell cancer or castrate-resistant prostate cancer who have failed or are not eligible for standard care.

Not a fit: Patients with early-stage cancers or those who have not yet undergone standard treatment may not benefit from this study.

Why it matters

Potential benefit: If successful, this trial could provide new treatment options for patients with advanced solid tumors who have limited alternatives.

How similar studies have performed: Other studies have shown promise with similar approaches targeting advanced solid tumors, indicating potential for success in this trial.

Eligibility criteria

To be eligible for inclusion in the dose escalation cohorts or expansion cohorts in this study, participants must meet all of the following criteria:

1. Participants must be ≥18 years of age.
2. Participants or their legal representative must be able to provide written informed consent to participate in the study prior to the performance of any study-specific procedures.
3. Diagnosis of histologically or cytologically confirmed advanced selected solid tumors:

   Cohort A - TT-10 dose escalation:
   1. RCC: Participants with locally advanced or metastatic RCC that have previously received at least two prior systemic regimens, including vascular endothelial growth factor (VEGF)-targeted therapy and checkpoint inhibitor therapy
   2. CRPC: Participants with metastatic CRPC who have previously received a second-generation hormonal agent (unless contraindicated) and a taxane-based chemotherapy.
   3. SCCHN: Participants with advanced or metastatic SCCHN that is incurable by surgery or radiotherapy and that has progressed during or after a platinum-based chemotherapy and/or checkpoint inhibitor therapy (separately or in combination)
   4. NSCLC: Participants with metastatic NSCLC that is intolerant or resistant to standard therapy or for which no standard therapy is available

   Cohort B - TT-4 dose escalation:
   1. CRC: Participants with metastatic CRC that is intolerant or resistant to standard therapy or for which no standard therapy is available
   2. CRPC: Participants with metastatic CRPC who have previously received a second-generation hormonal agent (unless contraindicated) and a taxane-based chemotherapy
   3. NSCLC: Participants with metastatic NSCLC that is intolerant or resistant to standard therapy or for which no standard therapy is available
   4. Endometrial cancer: Participants with metastatic endometrial cancer that is intolerant or resistant to standard therapy or for which no standard therapy is available
   5. Ovarian cancer: Participants with metastatic ovarian cancer that is intolerant or resistant to standard therapy or for which no standard therapy is available

   Cohort C- TT-10 + TT- 4 dose escalation and expansion:

   a. The tumor types will include 1 or more of those enrolled in the respective Escalation Cohorts (A and B), and will be determined following review of the dose escalation data by the SMC.
4. Eastern Cooperative Oncology Group (ECOG) performance status (PS) score 0 - 1
5. Have measurable disease per RECIST 1.1 as assessed by the local site investigator/radiology. Lesions situated in a previously irradiated area are considered measurable if progression has been demonstrated in such lesions.

   a. Participants with CRPC who have metastatic disease that is non-measurable are eligible if screening PSA ≥ 2.0 ng/mL and with Sponsor approval
6. Failure to respond to standard therapy, or for whom no appropriate therapies are available (based on the judgment of the investigator)
7. Consent to baseline biopsy, with the following exceptions:

   1. Participants whose only site(s) of disease are in areas considered moderate or high risk may be enrolled without a fresh biopsy with Sponsor approval;
   2. Archival tissue may be submitted in lieu of a fresh biopsy if collected within 6 months of screening and without intervening systemic therapy.
8. Participants must have adequate hematologic function based on the following:

   * ANC ≥ 1.5 x 109/L
   * Platelet count ≥ 100 x 109/L
   * Hemoglobin ≥ 9.0 g/dL
9. Participants must have adequate hepatic function based on the following:

   * Total bilirubin \< 1.5 x upper limit of normal (ULN) (unless elevated due to Gilbert's syndrome)
   * ALT/AST ≤ 2.5 x ULN (≤ 5 x ULN for participants with known hepatic metastases)
10. Participants must have adequate renal function based on the following:

    * Serum creatinine ≤ 1.5 x ULN; or
    * Serum creatinine clearance ≥ 60 mL/min, as determined by Cockcroft-Gault equation
11. For women of childbearing potential (WCBP): negative urine pregnancy test (UPT) within 1 week before first treatment (WCBP defined as a sexually mature woman who has not undergone surgical sterilization or who has not been naturally post-menopausal for at least 12 consecutive months for women \> 55 years of age). WCBP should be placed on effective birth control directly after testing negative for pregnancy; if not, then WCBP should have a UPT on Day 1 of every cycle, prior to study intervention administration. Any positive or indeterminant UPT result must be confirmed by serum.

    a. Female participants of childbearing potential must use a highly effective mode of contraception or abstain from heterosexual activity for the duration of the study and for 120 days following the last dose of study intervention. A female is NOT of childbearing potential if she has undergone bilateral salpingoophorectomy or is menopausal, defined as an absence of menses for 12 consecutive months. Male participants must agree to use highly effective contraception.
12. Ability to adhere to the study visit schedule and all protocol requirements
13. Must be able to swallow capsules

Participants will be excluded from the study if they satisfy any of the following criteria at the Screening visit unless otherwise stated:

Participants are to be excluded from the study if they meet any of the following criteria:

1. Major surgery within 4 weeks prior to Screening
2. Participants with active CNS metastases; however, participants who have undergone radiation and/or surgery for the treatment of CNS metastases, who are neurologically stable and who are no longer taking pharmacologic doses of corticosteroids are eligible; participants with leptomeningeal metastases are not eligible.
3. Has received prior radiotherapy within 2 weeks of start of study intervention. Participants must have recovered from all radiation-related toxicities, not require corticosteroids and not have had radiation pneumonitis. A 1-week washout is permitted for palliative radiation (≤ 2 weeks of radiotherapy) to non-CNS disease.
4. Prior anti-cancer therapy within 4 weeks prior to the start of study intervention. A 2 week washout is acceptable for short-acting drugs (eg, tyrosine kinase inhibitors). Any treatment-related toxicities must be resolved to Grade 0 - 1.
5. Human immunodeficiency virus (HIV)-infected participants
6. Participants who are hepatitis B surface antigen positive are eligible if they have received hepatitis B virus (HBV) antiviral therapy for at least 4 weeks and have undetectable HBV viral load prior to enrollment.

   Note: Participants should remain on antiviral therapy throughout study intervention and follow local guidelines for HBV antiviral therapy post completion of study intervention.

   Hepatitis B screening tests are not required unless:
   * Known history of HBV infection
   * As mandated by local health authority
7. Participants with a history of hepatitis C virus (HCV) infection are eligible if HCV viral load is undetectable at Screening. Note: Participants must have completed curative antiviral therapy at least 4 weeks prior to enrollment.

   Hepatitis C screening tests are not required unless:
   * Known history of HCV infection
   * As mandated by local health authority
8. Participants who require immunosuppressive therapy including, but not limited to, treatment with corticosteroids in pharmacologic doses (equivalent to ≥ 10 mg prednisone daily), cyclosporine, mycophenolate, azathioprine, methotrexate, adalimumab, infliximab, vedolizumab, tofacitinib, dupilumab, rituximab, etc. or systemic steroids (except for steroid use as cortisol replacement therapy in documented adrenal insufficiency)
9. Participants requiring administration of drugs known to be strong inhibitors or inducers of CYP3A4, 2C9 or 2C19
10. Participants requiring drugs that modify gastric pH, such as proton-pump inhibitors (PPIs) or H2 blockers. Antacids, such as calcium carbonate or aluminum hydroxide-based products, will be allowed during the study, but are recommended to be taken either 4 hours before or 2 hours after dosing of TT 10 (PORT 6) or PORT-7.
11. Ongoing systemic bacterial, fungal or viral infections at Screening

    a. NOTE: Participants on antimicrobial, antifungal or antiviral prophylaxis are not specifically excluded if all other inclusion/exclusion criteria are met
12. Administration of a live vaccine within 6 weeks of first dose of study intervention. Messenger ribonucleic acid (mRNA) vaccines for the prevention of Coronavirus Disease 2019 (COVID-19) infection are permitted.
13. Baseline QT interval corrected with Fridericia's method (QTcF) \> 470 ms (average of triplicate readings)

    a. NOTE: Criterion does not apply to participants with a right or left bundle branch block.
14. Prior surgery or gastrointestinal dysfunction that may affect drug absorption (eg, gastric bypass surgery, gastrectomy)
15. Female participants who are pregnant or breastfeeding
16. Concurrent active malignancy other than non-melanoma skin cancer, carcinoma in situ of the cervix or prostate intraepithelial neoplasia
17. Past medical history of interstitial lung disease, drug-induced interstitial lung disease, radiation pneumonitis which required steroid treatment, or any evidence of clinically active interstitial lung disease
18. History of peptic ulcer and/or gastrointestinal bleed within the past 6 months prior to Screening
19. History of stroke, unstable angina, myocardial infarction or ventricular arrhythmia requiring medication or mechanical control within the last 6 months prior to Screening
20. Unstable or severe uncontrolled medical condition (eg, unstable cardiac function, unstable pulmonary condition including pneumonitis and/or interstitial lung disease, uncontrolled diabetes) or any important medical illness or abnormal laboratory finding that would, in the investigator's judgment, increase the risk to the participant associated with his or her participation in the study

Where this trial is running

Los Angeles, California and 2 other locations

• USC Norris Comprehensive Cancer Center — Los Angeles, California, United States (Recruiting)
• Norton Cancer Institute — Louisville, Kentucky, United States (Recruiting)
• The University of Texas MD Anderson Cancer Center — Houston, Texas, United States (Recruiting)

Study contacts

• Study coordinator: Desa Rae E Stanton-Pastore, MS

Conditions Renal Cell Cancer; Castrate Resistant Prostate Cancer; Non Small Cell Lung Cancer; Head and Neck Squamous Cell Carcinoma; Colorectal Cancer; Endometrial Cancer; Ovarian Cancer; Failed or not eligible for standard of care