M7824 (MSB0011359C) in Combination With Gemcitabine in Adults With Previously Treated Advanced Adenocarcinoma of the Pancreas
M7824 (MSB0011359C) in Combination With Gemcitabine in Adults With Previously Treated Advanced Adenocarcinoma of the Pancreas
Background:

 Pancreas cancer ranks 4th in all cancer-related deaths in the U.S. Gemcitabine is a standard
 treatment for it. M7824 blocks a pathway that prevents the immune system from effectively
 fighting cancer. The two drugs together might help people with pancreas cancer.

 Objective:

 To test if giving M7824 together with gemcitabine is safe and causes tumors to shrink.

 Eligibility:

 People ages 18 and older with pancreatic cancer already treated with standard therapies

 Design:

 Participants will be screened with:

 Medical history

 Physical exam

 Scans in a machine that takes pictures of the body

 Blood, urine, and heart tests

 Some participants may have a tumor sample removed.

 Participants will get M7824 by IV once every 2 weeks. They will continue until their disease
 gets worse or they have unacceptable side effects. In addition they will get

 Participants will get gemcitabine by IV once weekly for 7 weeks. Then they will get it as
 follows for up to 6 months: Skip 1 week, get the drug once a week for 3 weeks, skip 1 week.

 .

 Before treatment on the first day of each cycle, participants will repeat screening tests.
 They will also have:

 Optional tumor biopsies before and after 3 cycles of therapy

 Questions about their well-being and function

 Genetic testing of tissue and blood samples

 Participants will have a follow-up visit 4 5 weeks after they stop therapy. This includes a
 physical exam, blood and urine tests, and maybe a scan. If their disease does not get worse,
 they will be invited for scans every 12 weeks.
Background:

 -  M7824 is an investigational agent in phase IB/II clinical development with dual activity
 against TGF-beta signaling (TGF-beta ligand trap ; extracellular domain of human
 TGF-beta receptor II) and immune checkpoint ligand inhibition (PD-L1 inhibition;
 avelumab, fully human IgG1 mAb directed against human PD-L1) with an acceptable toxicity
 profile and early signals of anti-cancer activity including in pancreas cancer.

 -  Gemcitabine (2 <=,2 <=-Difluordesoxycytidine) is a standard-of-care nucleoside analogue
 in pancreas cancer with immunomodulatory mechanisms of actions in pancreas cancer
 patients.

 -  Preclinical studies in authochtenous and syngeneic murine models have shown that
 TGF-beta inhibition and PD-L1 inhibition cooperate with gemcitabine to achieve reduction
 of tumor growth and extension of survival induce anti-tumor immunity, and reprogram the
 immune landscape.

 Objectives:

 -  To determine the safety and tolerability of M7824 in combination with gemcitabine in
 subjects with metastatic or locally advanced pancreas cancer.

 -  To determine best overall response (BOR) rate according to Response Evaluation Criteria
 (RECIST 1.1) in advanced pancreas cancer subjects.

 Eligibility:

 -  Histologically confirmed diagnosis of adenocarcinoma of the pancreas.

 -  Patients must have progressed on prior chemotherapeutic regimen.

 -  Concurrent treatment with non-permitted drugs and other interventions, prior therapy
 with gemcitabine or any antibody / drug targeting T cell co-regulatory proteins (immune
 checkpoints) such as anti-PD 1, anti PD-L1, or anti-cytotoxic T lymphocyte antigen-4
 (CTLA 4 antibody) is not allowed.

 Design:

 - The proposed study is a phase IB/II study of M7824 in combination with gemcitabine in a
 safety run-in of 6-18 patients and, if safe and tolerated, will proceed to an expansion phase
 II cohort with a standard Simon Minimax design .
-  INCLUSION CRITERIA:

 -  Patient must be able to understand and willing to sign a written informed consent
 document

 -  Age greater than of equal to 18 years. Because no dosing or adverse event data are
 currently available on the use of M7824 in combination with gemcitabine in patients
 <18 years of age, children are excluded from this study, but will be eligible for
 future pediatric trials

 -  Histologically or cytologically proven pancreatic adenocarcinoma (subjects with
 endocrine or acinar pancreatic carcinoma are not eligible).

 -  Patients must have disease that is not amenable to potentially curative resection.

 -  Subjects must have progressed on or after standard first-line systemic chemotherapy.

 -  ECOG performance status of 0 to 1

 -  Must have evaluable or measurable disease per RECIST 1.1.

 -  Adequate hematological function defined by:

 -  white blood cell (WBC) count greater than or equal to 3x10(9)/L

 -  with absolute neutrophil count (ANC) greater than or equal to 1.5x10(9)/L

 -  lymphocyte count greater than or equal to 0.5x10(9)/L,

 -  platelet count greater than or equal to 120x10(9)/L, and

 -  Hgb greater than or equal to 9 g/dL (in absence of blood transfusion)

 -  Adequate hepatic function defined by:

 -  a total bilirubin level less than or equal to 1.5xULN,

 -  an AST level less than or equal to 2.5xULN,

 -  ALT level less than or equal to 2.5Xuln.

 -  Adequate renal function defined by:

 -  Creatinine up to 1.5 upper institutional limits OR creatinine clearance (CrCl)
 >50 mL/min/1.73 m2 OR within normal as predicted by the Cockcroft-Gault formula:

 CrCl=(140-age) x (weight in kg) x (0.85, if female)/72 x Serum Creatinine (mg/dL)

 - The effects of the study treatment on the developing human fetus are unknown; thus, women
 of childbearing potential and men must agree to use adequate contraception (hormonal or
 barrier method of birth control; abstinence) within 28 days prior to study entry, for the
 duration of study participation and up to 120 days after the last dose of the drug. Should
 a woman become pregnant or suspect she is pregnant while she or her partner is
 participating in this study, she should inform her treating physician immediately.

 EXCLUSION CRITERIA:

 -  Patients who are receiving any other investigational agents

 -  Prior therapy with any antibody / drug targeting T cell coregulatory proteins (immune
 checkpoints) such as anti-PD-1, anti-PD-L1, or anti-CTLA-4 antibody.

 -  Anticancer treatment within designated period before enrollment including:

 -  minor surgical procedure (such as biliary stenting) within 14 days

 -  major surgical procedure or radiation treatment within 28 days

 -  chemotherapy or experimental drug treatment with published half-life known to be
 72 hours within 14 days

 -  experimental drug treatment with unpublished or half-life greater than 72 hours
 within 28 days

 -  radiotherapy for measurable lesions delivered in a normal organ-sparing technique
 within 21 days (except for palliative radiotherapy)

 -  Concurrent treatment with non-permitted drugs including herbal remedies with
 immunostimulating properties (for example, mistletoe extract) or known to potentially
 interfere with major organ function (for example, hypericin).

 -  Previous malignant disease (other than the target malignancy to be investigated in
 this trial) within the last 3 years. Subjects with a history of cervical carcinoma in
 situ, superficial or no-invasive bladder cancer, or basal cell or squamous cell
 carcinoma in situ previously treated with curative intent are NOT excluded.

 -  Rapidly progressive disease which, in the opinion of the Investigator, may predispose
 to inability to tolerate treatment or trial procedures.

 -  Subjects with active central nervous system (CNS) metastases causing clinical symptoms
 or metastases that require therapeutic intervention are excluded. Subjects with a
 history of treated CNS metastases (by surgery or radiation therapy) are not eligible
 unless they have fully recovered from treatment, demonstrated no progression for at
 least 2 months, and do not require continued steroid therapy. Subjects with CNS
 metastases incidentally detected during Screening which do not cause clinical symptoms
 and for which standard of care suggests no therapeutic intervention is needed are
 eligible.

 -  Receipt of any organ transplantation, including allogeneic stem-cell transplantation,
 except of transplants that do not require immunosuppression (e.g., corneal transplant,
 hair transplant)

 -  Significant acute or chronic infections including tuberculosis (history of exposure or
 history of positive tuberculosis test; plus, presence of clinical symptoms, physical
 or radiographic findings)

 -  Active autoimmune disease that might deteriorate when receiving an immunostimulatory
 agent with the exceptions:

 -  diabetes type I, vitiligo, alopecia, psoriasis, hypo- or hyperthyroid disease not
 requiring immunosuppressive treatment are eligible;

 -  subjects requiring hormone replacement with corticosteroids are eligible if the
 steroids are administered only for the purpose of hormonal replacement and at
 doses less than or equal to 10 mg of prednisone or equivalent per day;

 -  administration of steroids for other conditions through a route known to result
 in a minimal systemic exposure (topical, intranasal, intro-ocular, or inhalation)
 is acceptable.

 -  Known severe hypersensitivity reactions to monoclonal antibodies (Grade greater than
 or equal to 3 NCI-CTCAE v4.03), any history of anaphylaxis or history of uncontrolled
 asthma.

 -  Known severe hypersensitivity to gemcitabine.

 -  Female patients who are pregnant or breastfeeding. Because there is an unknown but
 potential risk for adverse events in nursing infants secondary to treatment of the
 mother with M7824 in combination with gemcitabine, breastfeeding should be
 discontinued.

 -  Known alcohol or drug abuse.

 -  Clinically significant cardiovascular / cerebrovascular disease as follows: cerebral
 vascular accident / stroke (< 6 months prior to enrollment), myocardial infarction (<
 6 months prior to enrollment), unstable angina, congestive heart failure (New York
 Heart Association Classification Class greater than or equal to II), or serious
 cardiac arrhythmia.

 -  Clinically relevant diseases (for example, inflammatory bowel disease) and / or
 uncontrolled medical conditions, which, in the opinion of the Investigator, might
 impair the subject s tolerance or ability to participate in the trial.

 -  Vaccine administration of live vaccines within 28 days of enrollment.

 -  Patients with known contrast allergies requiring pre-medication with steroids.

 -  HIV, HCV, HBV positive patients on antiviral drugs are excluded due to the absence of
 previous experience with concurrent use of antiviral medications and the
 investigational drug product to be evaluated in the current study and possible for
 adverse pharmacokinetic and/or pharmacodynamic interactions.

 -  Known inherited bleeding disorder and/or history of bleeding diathesis such as vWF
 deficiency.