A Study of MEDI1191 in Sequential and Concurrent Combination With Durvalumab in Subjects With Advanced Solid Tumors

This is a multicenter, open-label study to evaluate MEDI1191 delivered by intratumoral injection in sequential and concurrent combination with intravenous durvalumab to subjects with solid tumors. The study has a dose escalation design using mTPI-2 to evaluate a range of doses.

Inclusion criteria

• ECOG 0 to 1.
• Adequate organ function within 2 weeks of starting study treatment.
• Prior to the first dose of MEDI1191, subjects with central nervous system (CNS) metastases must have been treated and must be asymptomatic.
• Cessation of systemic corticosteroids at doses exceeding 12 mg/day prednisone or equivalent, methotrexate, azathioprine, ustekinumab (Stelara®), and tumor necrosis factor (TNF)-α/IL-6 blockers for at least 7 days prior to the first dose of MEDI1191.
• Subjects must have at least one lesion suitable for intratumoral dosing for superficial lesions but at least two lesion suitable for intratumoral dosing for deep-seated lesions.
• Subjects must have at least one non-injected lesion that can be measured by RECIST v1.1.
• Histologic or cytologic confirmation of advanced solid tumor.
• Received and have progressed on or refractory to at least 1 line of standard systemic therapy in the recurrent/metastatic setting.
• Highly effective method of contraception from screening, and must agree to continue using such precautions for 3 months after the final dose of investigational product.
• Nonsterilized male subjects who are sexually active with a female partner of childbearing potential must use a male condom with spermicide from Day 1 through 3 months after receipt of the final dose of investigational product.

Exclusion criteria

• Subjects who have received prior IL-12 either alone or as part of a treatment regimen.
• Subjects who were administered any live attenuated vaccines within 30 days prior to first MEDI1191 injection.
• Known allergy or hypersensitivity to any component of MEDI1191 or durvalumab formulations.
• Active or prior documented autoimmune disorders within the past 5 years prior to the first scheduled dose of study treatment except alopecia, hypothyroidism (stable of hormone replacement), chronic skin condition (does not require systemic therapy), and celiac disease (controlled by diet alone).
• Immune-deficiency states - myelodysplastic disorders, marrow failure states, human immunodeficiency virus infection, history of solid organ transplant, bone marrow allograft, or active tuberculosis.
• History of coagulopathy resulting in uncontrolled bleeding or other bleeding disorders.
• Require continuous anticoagulation or antiplatelet therapy (except for ≤ 100 mg acetylsalicylic acid [ASA]) which cannot be interrupted for more than 7 days for IT delivery of MEDI1191.
• Any concurrent chemotherapy, radiotherapy, immunotherapy, biologic or hormonal therapy for cancer.
• Receipt of any conventional or investigational anticancer therapy within 21 days or palliative radiotherapy within 7 days prior to the first dose of study treatment. For subjects who have received prior immunotherapy, the following additional exclusion criteria apply:

• Received only one dose of prior immunotherapy agent alone or as part of a combination regimen
• Experienced a toxicity that led to permanent discontinuation of prior immunotherapy
• All AEs while receiving prior immunotherapy did not resolve to ≤ Grade 1 or baseline prior to screening for this study.
• Experienced a ≥ Grade 3 AE (including pneumonitis) or neurologic, ocular, or cardiac AE of any grade while receiving prior immunotherapy.
• Required the use of additional immunosuppression other than corticosteroids for the management of an AE, or experienced recurrence of an AE if re-challenged, or is currently requiring a maintenance dose of > 12 mg prednisone or equivalent per day.
• Any toxicity from prior therapy that has not completely resolved to ≤ Grade 1 or baseline at the time of consent.
• Current or prior use of immunosuppressive medication within 14 days prior to the first dose of MEDI1191, except intranasal, topical, inhaled corticosteroids, local steroid injections, systemic corticosteroids at physiologic doses not to exceed 12 mg/day of prednisone or equivalent, or steroids as premedication for hypersensitivity reactions.
• Cardiac exclusions: New York Heart Association Class 3 or 4 congestive heart failure, uncontrolled hypertension, acute coronary syndrome within 6 months.
• Any condition that would interfere with evaluation of the investigational product or interpretation of subject safety or study results.
• Uncontrolled intercurrent illness.
• Untreated, active hepatitis B or C.
• Major surgery within 4 weeks prior to first dose of MEDI1191 or still recovering from prior surgery.
• Subjects with untreated active major depression with suicidal ideation and/or plan.
• Female subjects who are pregnant, lactating, or intend to become pregnant during their participation in this study.