Overview

Phase 3 Study of Upifitamab Rilsodotin Maintenance in Platinum-Sensitive Recurrent Ovarian Cancer (UP-NEXT)

Status:
Not yet recruiting
Trial end date:
2025-03-04
Target enrollment:
0
Participant gender:
Female
Summary
UP-NEXT is a double-blind, randomized, placebo controlled study of the antibody-drug conjugate (ADC) XMT-1536 (upifitamab rilsodotin) administered as an intravenous infusion for patients once every four weeks. Patients with recurrent, platinum-sensitive high-grade serous ovarian cancer (HGSOC) including fallopian tube and primary peritoneal cancer expressing high levels of NaPi2b.
Phase:
Phase 3
Accepts Healthy Volunteers?
No
Details
Lead Sponsor:
Mersana Therapeutics
Collaborators:
European Network of Gynaecological Oncological Trial Groups (ENGOT)
GOG Foundation
Treatments:
Immunoconjugates
Criteria
Inclusion Criteria:

1. Participants must be at least 18 years of age, and female.

2. Participant must have an ECOG performance status 0 or 1

3. Participant must have a histological diagnosis of high grade serous ovarian cancer,
which includes fallopian tube and primary peritoneal cancer, that is metastatic or
recurrent.

4. Participant must be able to understand the study procedures and agree to participate
in the study by providing written informed consent.

5. Participant must have platinum-sensitive recurrent disease, defined as having achieved
either a partial or complete response to 4 or more cycles in their penultimate
platinum- containing regimen and their disease progressing more than 6 months after
completion of the last dose of platinum containing therapy in the penultimate regimen.

6. Participant must have had 4 to 8 cycles of platinum-based chemotherapy in 2nd to 4th
line setting in their most recent treatment regimen as defined below:

1. Platinum-based chemotherapy regimens allowed immediately preceding enrollment to
the study: carboplatin or cisplatin ±: paclitaxel, docetaxel, pegylated liposomal
doxorubicin or gemcitabine.

2. Participant must receive first study treatment infusion between 4 and 12 weeks
after completing final dose of platinum in the most recent platinum-based
regimen.

3. Definitions for prior lines of therapy:

- Adjuvant ± neoadjuvant considered one line of therapy as long as they are
the same regimens (e.g., platinum/taxane for 4 cycles before surgery
followed by platinum/taxane for 4 cycles after surgery)

- Maintenance therapy (e.g., bevacizumab, PARPi, endocrine therapy) will be
considered as part of the preceding line of therapy (i.e., not counted
independently)

- Therapy given for only 1 cycle and discontinued due to toxicity in the
absence of progression will not be counted as a new line of therapy; therapy
given for 2 or more cycles will be counted as a line of therapy.
Substitutions of different platinum agents or taxanes will not be counted as
new lines.

- Hormonal therapy (e.g., tamoxifen, letrozole) will be counted as a separate
line of therapy unless given as maintenance.

7. Participant must have had as their best response to last line of treatment one of the
following: No Evidence of Disease (NED); Complete Response (CR); Partial Response
(PR); OR Stable Disease (SD)

8. Participants with NED, CR, or PR as their best response to most recent line of
treatment and who have not received treatment with a prior PARP inhibitor must have
definitive BRCA1 and BRCA2 testing results that demonstrate no evidence of a
deleterious BRCA1 or BRCA2 mutation. Somatic BRCA mutation testing is required for
participants who are classified as not having a deleterious mutation by germline
testing alone.

9. Participant must provide either a tumor tissue block or fresh cut slides for
measurement of NaPi2b expression by a central laboratory. If sufficient archival tumor
tissue is not available, then a tumor tissue block or slides must be obtained from a
fresh biopsy and provided to the central laboratory. Confirmation of a
NaPi2b-H/positive tumor by the central laboratory is required prior to randomization.

10. Participants with toxicity from prior therapy or surgical procedures must have
recovered to Grade ≤1. Participants with alopecia, stable immune-related toxicity such
as hypothyroidism on hormone replacement, adrenal insufficiency treated with ≤10 mg
daily prednisone (or equivalent), or chronic Grade 2 peripheral sensory neuropathy
after prior taxane therapy is an exception to this criterion and may qualify for this
study.

11. Participants must have cardiac left ventricular ejection fraction (LVEF) ≥50% or ≥ the
institution's lower limit of normal as measured by either Echo or MUGA scan

12. Participants must have adequate organ function within 14 days prior to enrollment

13. During the study, female study participants of child-bearing potential (WOCBP) must a
contraceptive method that is highly effective during study treatment and for at least
6 months after the last dose of study treatment.

Exclusion Criteria:

1. Participant has received prior treatment with mirvetuximab soravtansine or another ADC
containing an auristatin or maytansinoid payload.

2. Participant has received bevacizumab in combination with last platinum-based regiment
or plans to receive maintenance therapy outside the study intervention.

3. Participant has clinical signs or symptoms of gastrointestinal obstruction and/or
requirement for parenteral hydration or nutrition.

4. Participant has ascites or pleural effusion managed with therapeutic paracentesis or
thoracentesis within 28 days prior to signing the principal study consent form.

5. Participant has history of cirrhosis, hepatic fibrosis, esophageal or gastric varices,
or other clinically significant liver disease. Testing beyond laboratory studies
otherwise defined in the eligibility criteria, to diagnose potentially clinically
significant liver disease based on risk factors such as hepatic steatosis or history
of excessive alcohol intake, will be based on clinical judgement of the investigator.

6. Participants cannot receive drugs associated with hepatotoxicity concurrent with
upifitamab rilsodotin administration except as outlined in Appendix 4.

7. Participant currently uses either constant or intermittent supplementary oxygen
therapy.

8. Participant has history of or suspected pneumonitis or interstitial lung disease.

9. Participant has oxygen saturation on room air <93%.

10. Participant has had major surgery or systemic anti-cancer therapy within 28 days of
starting study treatment.

11. Participant has a low-grade, clear cell, endometrioid, mucinous, carcinosarcoma, germ-
cell, mixed histology, or stromal tumor.

12. Participant has untreated CNS metastases (including new and progressive brain
metastases), history of leptomeningeal metastasis, or carcinomatous meningitis.

1. Participants are eligible if CNS metastases are adequately treated and are
neurologically stable for at least 2 weeks prior to enrollment.

2. In addition, participants must be either off corticosteroids, or on a
stable/decreasing dose of ≤ 10 mg daily prednisone (or equivalent).
Anticonvulsants are allowed except for those drugs associated with liver
toxicity.

13. Participant has untreated, known human immunodeficiency virus (HIV), hepatitis B virus
(HBV), or hepatitis C virus (HCV). In addition, negative serology is required during
screening (baseline) for HBV and HCV:

- HBV: Participants with serologic evidence of chronic HBV infection should have an
HBV viral load below the limit of quantification to be eligible.

- HCV: Participants with a history of HCV infection should have completed curative
antiviral treatment and HCV viral load below the limit of quantification.

- Screening for HIV is not required except if mandated by local regulations or
indicated based on clinical assessment.

14. Participant has current severe, uncontrolled systemic disease (e.g., clinically
significant cardiovascular, pulmonary, or metabolic disease) or intercurrent illness
that could interfere with per-protocol evaluations. Further, participants are excluded
with the following characteristics:

1. A marked baseline prolongation of QTcF interval CTCAE Grade >1: repeated
demonstration of a QTcF interval >480 milliseconds (ms) using Fridericia's QT
correction formula.

2. A history of additional risk factors for Torsades de Pointes (e.g., heart
failure, hypokalemia, family history of Long QT Syndrome).

15. Has a diagnosis of additional malignancy that required treatment within 2 years prior
to screening, except for adequately treated basal cell or squamous cell skin cancer,
or carcinoma in situ of the breast or of the cervix

16. Participant has clinically significant corneal disease.

17. Participant is unwilling to be transfused with blood components.

18. Participant is receiving concurrent anti-cancer therapy (e.g. chemotherapy, radiation
therapy, biologic therapy, immunotherapy, hormonal therapy, investigational therapy).

19. Participant is unable or unlikely to comply with dosing schedule and study
evaluations.

20. Participant is using strong CYP450 3A4 inhibitors or inducers that cannot be
discontinued while receiving study treatment (see Appendix 5).

21. Participants who are WOCBP must not be pregnant or nursing. Pregnancy status must be
confirmed with a negative highly sensitive pregnancy test (urine or serum as required
by local regulations) within 72 hours before the first dose of study treatment.