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A Study of HER3-DXd in Subjects With Locally Advanced or Metastatic Solid Tumors

NCT06172478 · Daiichi Sankyo
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Official title
HERTHENA-PanTumor01 (U31402-277): A Phase 2, Multicenter, Multicohort, Open-Label, Proof of Concept Study of Patritumab Deruxtecan (HER3-DXd; U3-1402) in Subjects With Locally Advanced or Metastatic Solid Tumors
About this study
This study is designed to assess the safety and efficacy of HER3-DXd monotherapy in subjects with refractory locally advanced unresectable or metastatic solid tumors who have been previously treated with ≥1 prior line of systemic anticancer therapy. The primary objective of the study is to assess the efficacy of HER3-DXd monotherapy for each type of indicated locally advanced unresectable or metastatic tumor. Secondary objectives include the assessment of safety and tolerability, efficacy, and pharmacokinetics of HER3-DXd monotherapy for each type of indicated locally advanced unresectable or metastatic tumor. HER3 protein expression in tumor tissue and its relationship with HER3-DXd efficacy will also be evaluated.
Eligibility criteria
Inclusion Criteria Participants must meet all of the following criteria to be eligible for enrollment into the study: 1. Sign and date the informed consent form prior to the start of any study-specific qualification procedures. A separate tissue screening consent will be obtained from all subjects to meet the baseline tumor tissue requirement. 2. Participants aged ≥18 years (follow local regulatory requirements if the legal age of consent for study participation is \>18 years old). 3. Has locally advanced unresectable or metastatic disease (not curable by surgery or radiation) as follows: Cutaneous (acral and non-acral) melanoma 1. Histologically or cytologically confirmed cutaneous (acral or non-acral) melanoma 2. Disease progression while on or after having received treatment with ≥1 prior line of anti-programmed cell death protein (PD-1) or anti-programmed death-ligand 1 (PD-L1) based therapy (previous use of other immune checkpoint inhibitors \[ICIs\] \[ie, anti-CTLA4, anti- LAG-3\] is acceptable). Prior anti-PD-(L)1 therapy in the adjuvant setting is allowed if there is recurrence within 12 weeks of the last dose. If the participant had BRAFm melanoma, they must have had disease progression on BRAF/MEK inhibitor therapy as well. Squamous cell carcinomas of the head and neck 3. Squamous cell carcinoma of the head and neck (with a primary location of oral cavity,oropharynx, larynx, hypopharynx) that is human papillomavirus (HPV) positive or negative (as determined by local standard). Excludes tumor location in the nasopharynx, nasal cavity, paranasal sinuses, and unknown primary locations. 4. Disease progression after having received treatment with ≥1 and \<3 prior lines of systemic therapy in the unresectable recurrent or metastatic setting. Must have had disease progression on anti-PD-(L)1 (either as monotherapy or in combination with chemotherapy or other therapies). Must also have had disease progression on a platinum-based chemotherapy (PBC) regimen either in the recurrent or metastatic setting or in the locally advanced setting with curative intent. Gastric or GEJ adenocarcinoma 5. Tumor tissue must be confirmed as negative for HER2 expression (immunohistochemistry \[IHC\] 0/1+ or IHC 2+/in situ hybridization negative) as classified by American Society of Clinical Oncology/College of American Pathologists (ASCO-CAP) guidelines and determined prior to enrollment by assessment in a local laboratory that is Clinical Laboratory Improvement Amendments certified (US sites) or accredited based on specific country regulations. 6. Disease progression after having received treatment with ≥2 prior lines of therapy that include PBC with or without anti-PD-1 therapy. Ovarian Carcinoma 7. Pathologically documented high-grade serous epithelial ovarian cancer, primary peritoneal cancer, or fallopian tube cancer. 8. Documented disease progression ≥4 weeks after the last dose of PBC and \<6 months of last dose of PBC in the advanced or metastatic setting. Prior use of folate reductase alpha targeting antibody-drug conjugate (ADC) (ie, mirvetuximab soravtansine) is allowed. Cervical Cancer 9. Pathologically or cytologically documented recurrent or persistent squamous, adenosquamous, or adenocarcinoma of the uterine cervix. 10. Disease progression after having received ≥1 line of systemic therapy in the recurrent or metastatic setting. This may include prior anti-PD-(L)1 treatment and/or tissue factor directed ADC (tisotumab vedotin \[TV\]) per regional standard of care. Endometrial Cancer 11. Pathologically or cytologically documented endometrial cancer (carcinoma of any histological sub-type or endometrial carcinosarcoma), irrespective of microsatellite instability (MSI) or mismatch repair (MMR) status. 12. Documented disease progression after having received ≥1 prior line of therapy (maximum of 3) PBC containing systemic treatment and an anti-PD(L)-1 therapy-containing regimen (combined or sequential) in the advanced/metastatic setting. Bladder Cancer 13. Pathologically or cytologically documented locally advanced/unresectable or metastatic urothelial carcinoma of the bladder, renal pelvis, ureter, or urethra. Histological variants are allowed if urothelial histology is predominant. Small cell/neuroendocrine tumors are not allowed even if mixed histology. 14. Relapsed or progressed after treatment with ≥1 prior line of therapy (maximum of 3) that contains anti-PD-(L)1 therapy in the perioperative or metastatic setting. At least 1 line of therapy must also contain one of the following treatment modalities: chemotherapy or enfortumab vedotin. Prior fibroblast growth factor receptor (FGFR)-inhibitor treatment for those who are eligible are allowed. * Required treatments can be given in combination or sequentially * Prior cisplatin-based therapy or PD-(L)1 inhibitor therapy given for the treatment of muscle invasive urothelial carcinoma is counted as 1 line of therapy * The same regimen administered twice in different disease settings will be counted as 1 line of prior therapy * Participants in the second-line setting who have previously received enfortumab vedotin and pembrolizumab in combination can be enrolled. Esophageal Carcinoma 15. Pathologically or cytologically documented esophageal squamous cell carcinoma. 16. Must have documented disease progression after having received 2 prior lines of therapy including previous PBC with or without an anti-PD-1 therapy-containing regimen (combined or sequential) in the advanced/metastatic setting. Pancreatic Carcinoma 17. Pathologically or cytologically documented unresectable or metastatic pancreatic adenocarcinoma. 18. Relapsed or disease progression after having received 1 prior line of systemic therapy in the locally advanced/metastatic setting. Prostate Cancer 19. Pathologically or cytologically documented unresectable locally advanced or metastatic castration-resistant prostate cancer (CRPC). 20. Adenocarcinoma of the prostate without neuroendocrine differentiation or small cell histology. 21. Surgically or medically castrated, with testosterone levels of \<50 ng/dL. 22. Documented objective progression as determined by radiographic progression for subjects with measurable disease after androgen deprivation. 23. Relapsed or disease progression after having received treatment with ≥1 of the following novel hormonal agents: abiraterone, enzalutamide, apalutamide, or darolutamide. 24. Relapsed or disease progression after having received ≥1 cytotoxic chemotherapy regimen that included a taxane. Gastric Cancer 2L 25. Must have had gastric or GEJ adenocarcinoma confirmed as negative for HER2 expression (IHC 0/1+ or IHC 2+/in situ hybridization negative) as classified by American Society of Clinical Oncology/College of American Pathologists (ASCO-CAP) guidelines and determined prior to enrollment by assessment in a local laboratory that is Clinical Laboratory Improvement Amendments certified (US sites) or accredited based on specific country regulations. 26. Disease progression after having received treatment with only 1 prior line of systemic anti-cancer therapy that includes 5-FU-based chemotherapy with or without an anti-PD-1 therapy. For subjects whose tumors are claudin (CLDN) 18.2 positive, treatment with 5-FU based chemotherapy with CLDN18.2 directed therapy in the first-line setting is allowed. Non-small Cell Lung Cancer aa. Histologically or cytologically documented metastatic or locally advanced nonsquamous NSCLC not amenable to curative surgery or radiation bb. Documentation of absence of actionable driver mutation (ie, ALK rearrangement, BRAF V600E mutation, EGFR-activating mutations \[exon 19 deletion or L858R mutation\], EGFR exon 20 insertion mutation, HER2 mutation, KRAS G12C mutation, MET exon 14 skipping mutation, NTRK 1/2/3 gene fusion, RET rearrangement, or ROS1 rearrangement). New testing for these genomic alterations is not required for Screening. cc. Relapsed or disease progression after receiving only anti-PD-(L)1 and PBC (ie, platinum doublet) administered in combination or sequentially for metastatic disease. Breast Cancer dd. Pathologically documented breast cancer that is assessed as HER2 negative (IHC2+/ISH-, IHC1+, or IHC0 per ASCO/CAP guidelines), and HR positive (either ER and/or PgR positive \[ER or PgR ≥1%\] per ASCO/CAP guidelines). The HER2 and HR results must be from a tumor sample obtained in the metastatic setting. ee. Participant must have received one line of chemotherapy for mBC, but not more than one line and must have a clinically or radiologically documented evidence of tumor progression on or after CDK 4/6 inhibitor combined with endocrine therapy; previous treatments with phosphoinositide 3-kinase (PI3K) inhibitors, mammalian target of rapamycin (mTOR) inhibitors, protein kinase B (PKB) inhibitors also known as AKT-inhibitors and poly ADP ribose polymerase (PARP)-inhibitors are allowed. 4. Has ≥1 measurable lesion on CT or MRI as per RECIST v1.1 by investigator assessment. Prostate cancer participants with bone only disease may be eligible. 5. Provides a pretreatment tumor tissue sample that meets 1 of the following collection requirements: 1. Tumor biopsy from ≥1 lesion not previously irradiated and performed since progression with the most recent systemic cancer therapy regimen and prior to signature of the tissue ICF (ARCHIVAL PRETREATMENT sample). OR 2. Newly obtained pretreatment tumor biopsy from ≥1 lesion not previously irradiated and amenable to sampling, after signature of tissue ICF (FRESH PRETREATMENT sample) 6. Has Eastern Cooperative Oncology Group performance status (ECOG PS) of 0 or 1 at screening. Exclusion Criteria Participants who meet any of the following criteria will be disqualified from entering the study: 1. Has HER2-positive gastric cancer as classified by ASCO-CAP guidelines and determined prior to enrollment by assessment in a local laboratory that is Clinical Laboratory Improvement Amendments certified (US sites) or accredited based on specific country regulations. 2. Has nasopharyngeal cancer. 3. Has mucosal or uveal melanoma. 4. Has a history of (non-infectious) interstitial lung disease (ILD), that required corticosteroids, has current ILD/pneumonitis, or suspected ILD/pneumonitis cannot be ruled out by imaging at screening. 5. Has clinically severe respiratory compromise (based on the investigator's assessment) resulting from intercurrent pulmonary illnesses 6. Is receiving chronic systemic corticosteroids dosed at \>10 mg prednisone daily or equivalent anti-inflammatory activity or any form of immunosuppressive therapy prior to Cycle 1 Day 1. Participants who require use of bronchodilators, inhaled or topical steroids, or local steroid injections may be included in the study. 7. Had prior treatment with an anti-HER3 antibody and/or antibody-drug conjugate (ADC) that consists of an exatecan derivative that is a topoisomerase I inhibitor (eg, trastuzumab deruxtecan). 8. Has history of other active malignancy within 3 years prior to Cycle 1 Day 1, except the following: 1. Adequately treated nonmelanoma skin cancer 2. Adequately treated intraepithelial carcinoma of the cervix 3. Any other curatively treated in situ disease 9. Has any evidence of severe or uncontrolled diseases (eg, active bleeding diatheses, active serious infection) psychiatric illness/social situations, geographical factors, substance abuse, or other factors that, in the investigator's opinion, make it high risk for the subject to participate in the study or that would jeopardize compliance with the protocol 10. Has previously received topoisomerase-1 inhibitors (e.g., irinotecan) treatment in the advanced or metastatic disease setting.
Study design
Enrollment target: 740 participants
Allocation: na
Masking: none
Age groups: adult, older_adult
Timeline
Starts: 2024-02-26
Estimated completion: 2028-10-10
Last updated: 2026-01-28
Interventions
Drug: HER3-DXd
Primary outcomes
  • Number of Participants With Objective Response Rate Assessed by Investigator Following HER3-DXd Monotherapy (All Cohorts Except Prostate Cancer Cohort) (Baseline up until documented progressive disease, death, lost to follow-up, or withdrawal by the participant, up to approximately 27 months)
  • Proportion of Participants Achieving a ≥50% Decrease in PSA (Prostate Cancer Cohort Only) (Baseline, each cycle before infusion (each cycle is 21 days), and end of treatment, up to approximately 27 months)
Sponsor
Daiichi Sankyo · industry
With: Merck Sharp & Dohme LLC
Contacts & investigators
ContactDaiichi Sankyo Contact for Clinical Trial Information · contact · CTRinfo@dsi.com · 9089926400
InvestigatorGlobal Clinical Leader · study_director, Daiichi Sankyo
All locations (84)
City of HopeRecruiting
Duarte, California, United States
Yale Cancer CenterRecruiting
New Haven, Connecticut, United States
AdventHealth Medical Group Oncology Research at CelebrationRecruiting
Kissimmee, Florida, United States
University of Illinois Cancer CenterRecruiting
Chicago, Illinois, United States
Johns Hopkins UniversityRecruiting
Baltimore, Maryland, United States
Health Partners Frauenshuh Cancer CenterRecruiting
Saint Louis Park, Minnesota, United States
Health Partners Cancer Center at Regions HospitalRecruiting
Saint Paul, Minnesota, United States
Washington University, School of MedicineRecruiting
St Louis, Missouri, United States
Roswell Park Cancer Institute IDSRecruiting
Buffalo, New York, United States
Memorial Sloan Kettering HospitalRecruiting
New York, New York, United States
SCRI Oncology PartnersRecruiting
Nashville, Tennessee, United States
The University of Texas MD Anderson Cancer CenterRecruiting
Houston, Texas, United States
Fred Hutchinson Cancer CenterRecruiting
Seattle, Washington, United States
Chris O'Brien LifehouseRecruiting
Camperdown, Australia
Icon Cancer Centre ChermsideRecruiting
Chermside, Australia
Monash Medical Centre ClaytonRecruiting
Clayton, Australia
Icon Cancer Centre HobartRecruiting
Hobart, Australia
Icon Cancer Centre TownsvilleRecruiting
Hyde Park, Australia
Cliniques Universitaires Saint-LucRecruiting
Brussels, Belgium
UZARecruiting
Edegem, Belgium
Universitair Ziekenhuis GentRecruiting
Ghent, Belgium
Universitair Ziekenhuis BrusselRecruiting
Jette, Belgium
UZ LeuvenRecruiting
Leuven, Belgium
Cross Cancer InstituteRecruiting
Edmonton, Alberta, Canada
Sunnybrook Research InstituteRecruiting
Toronto, Canada
Princess Margaret Cancer CentreRecruiting
Toronto, Canada
BC Cancer - VancouverRecruiting
Vancouver, Canada
Sun Yat-sen University Cancer CenterRecruiting
Guangzhou, China
Chu BordeauxRecruiting
Bordeaux, France
Centre Georges Franăois LeclercRecruiting
Dijon, France
Hopital Claude Huriez - Chu LilleRecruiting
Lille, France
Centre Léon BérardRecruiting
Lyon, France
Hăpital de La TimoneRecruiting
Marseille, France
Chu Nantes - Hătel DieuRecruiting
Nantes, France
Institut Claudius RegaudRecruiting
Toulouse, France
ICL - Alexis VautrinRecruiting
Vandœuvre-lès-Nancy, France
Institut Gustave RoussyRecruiting
Villejuif, France
Krankenhaus Nordwest GmbHRecruiting
Frankfurt, Germany
Bacs-Kiskun Varmegyei OktatokorhazRecruiting
Kecskemét, Hungary
Humanitas GavazzeniRecruiting
Bergamo, Italy
IRCCS Ospedale Policlinico San MartinoRecruiting
Genova, Italy
AOU Federico II - Oncologia ClinicaRecruiting
Naples, Italy
Centro Ricerche Cliniche di Verona s.r.l.Recruiting
Verona, Italy
Saitama Medical University International Medical CenterRecruiting
Hidaka, Japan
National Cancer Center Hospital EastRecruiting
Kashiwa-shi, Japan
NHO Shikoku Cancer CenterRecruiting
Matsuyama, Japan
Shizuoka Cancer CenterRecruiting
Nagaizumi-cho, Japan
Aichi Cancer Center HospitalRecruiting
Nagoya, Japan
Kindai University HospitalRecruiting
Osakasayama-shi, Japan
National Cancer Center HospitalRecruiting
Tokyo, Japan
Cancer Institute Hospital of JFCRRecruiting
Tokyo, Japan
Yokohama City University Medical CenterRecruiting
Yokohama, Japan
Amsterdam UMC locatie VumcRecruiting
Amsterdam, Netherlands
Universitair Medisch Centrum GroningenRecruiting
Groningen, Netherlands
Leids Universitair Medisch CentrumRecruiting
Leiden, Netherlands
Maastricht University Medical CenterRecruiting
Maastricht, Netherlands
Radboud University Medical CenterRecruiting
Nijmegen, Netherlands
Akershus universitetssykehusRecruiting
Lørenskog, Norway
Haukeland universitetssjukehusRecruiting
Lørenskog, Norway
Oslo Universitetssykehus HF, RadiumhospitaletRecruiting
Oslo, Norway
Cha Bundang Medical Center, Cha UniversityRecruiting
Seongnam, South Korea
Seoul National University Bundang HospitalRecruiting
Seongnam, South Korea
Seoul National University HospitalRecruiting
Seoul, South Korea
Severance Hospital, Yonsei University Health SystemRecruiting
Seoul, South Korea
Asan Medical CenterRecruiting
Seoul, South Korea
Samsung Medical CenterRecruiting
Seoul, South Korea
Hospital Universitari Vall D'HebronRecruiting
Barcelona, Spain
Hospital Clinic de BarcelonaRecruiting
Barcelona, Spain
Hospital de La Santa Creu I Sant PauRecruiting
Barcelona, Spain
Hospital General Universitario Gregorio MarañonRecruiting
Madrid, Spain
Hospital Universitario Ramon Y CajalRecruiting
Madrid, Spain
Hospital Universitario 12 de OctubreRecruiting
Madrid, Spain
HOSPITAL REGIONAL UNIVERSITARIO de MALAGA AVDA.Recruiting
Málaga, Spain
Hospital Universitario Virgen MacarenaRecruiting
Seville, Spain
Hospital Clinico Universitario de ValenciaRecruiting
Valencia, Spain
Kaohsiung Chang Gung Memorial HospitalRecruiting
Kaohsiung City, Taiwan
National Cheng Kung University HospitalRecruiting
Tainan, Taiwan
National Taiwan University HospitalRecruiting
Taipei, Taiwan
Taipei Veterans General HospitalRecruiting
Taipei, Taiwan
Chang Gung Memorial HospitalRecruiting
Taoyuan District, Taiwan
University Hospital CoventryRecruiting
Coventry, United Kingdom
Barts HospitalRecruiting
London, United Kingdom
Royal Free HospitalRecruiting
London, United Kingdom
Nottingham City Hospital CampusRecruiting
Nottingham, United Kingdom