A Phase 2 interventional study of Cobomarsen and Vorinostat in Cutaneous T-Cell Lymphoma/Mycosis Fungoides, sponsored by miRagen Therapeutics, Inc.. Terminated at 43 sites in 8 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2022-04-08.
Sponsored by miRagen Therapeutics, Inc. · Phase 2, Interventional, and Treatment
The main objective of this clinical trial is to study the efficacy and safety of cobomarsen (also known as MRG-106) for the treatment of cutaneous T-cell lymphoma (CTCL), mycosis fungoides (MF) subtype. Cobomarsen is designed to inhibit the activity of a molecule called miR-155 that may be important to the growth and survival of MF cancer cells. The study will compare the effects of cobomarsen to vorinostat, a drug that has been approved for the treatment of CTCL in the United States and several other countries.
Participants in the clinical trial will be randomly assigned to receive either weekly doses of cobomarsen by injection into a vein or daily oral doses of vorinostat. Participants will continue on their assigned treatment as long as there is no evidence of progression of their cancer. The effects of treatment will be measured based on changes in skin lesion severity, as well as the length of time that the subject's disease remains stable or improved, without evidence of disease progression. The safety and tolerability of cobomarsen will be assessed based on the frequency and severity of observed side effects.
Participants assigned to receive vorinostat who experience progression of their disease during their participation in this study may have the option to be treated with cobomarsen in an open-label, crossover arm of the same study if they meet the entry criteria for that part of the study.
Study Design:
Subjects will be randomly assigned in a 1:1 ratio to receive either cobomarsen or vorinostat. Approximately 126 subjects (63 per arm) are expected to be enrolled. Cobomarsen will be administered in the clinic by 2-hr intravenous infusion on Days 1, 3, 5 and 8, and weekly thereafter. Vorinostat will be dispensed to study subjects and taken as a daily oral dose according to the manufacturer's labeled dosing instructions. Treatment will continue until the subject becomes intolerant, develops clinically significant side effects, progresses, or the trial is terminated. An interim analysis will be conducted after approximately 40 subjects have been followed for a minimum of approximately 6 months. Enrollment will be suspended until the completion of the interim analysis.
Key Inclusion Criteria:
Key Exclusion Criteria:
Cobomarsen will be administered by intravenous 2-hour infusion at a dose of 282 mg on Days 1, 3, 5, 8, and weekly thereafter
Drug: Cobomarsen
Vorinostat will be administered orally at a dose of 400 mg (four 100-mg capsules) once daily with food, at approximately the same time each day.
Drug: Vorinostat
At least weekly doses of cobomarsen (282 mg) throughout study treatment period
Also known as: MRG-106
Daily doses of vorinostat throughout study treatment period
Percentage of Subjects Achieving an Objective Skin Response of at Least 4 Months Duration (ORR4)
ORR4 is the percentage of subjects with a complete response (CR) or partial response (PR) in the skin for 4 consecutive months confirmed by repeat assessments no less than 28 days (± 3 days) later. The modified Severity Weighted Assessment Tool (mSWAT) is used to measure skin disease severity based on the percentage of body surface area (BSA) with patches, plaques, or tumors. Total scores are calculated by multiplying the BSA percentage for each category of lesion (patch, plaque, or tumor) by a weighting factor and adding the three sub-scores. Lower scores indicate a lower degree of skin disease severity. CR corresponds to 100% clearance of skin lesions present at baseline (mSWAT score of 0). PR corresponds to 50-99% clearance of skin disease present at baseline (at least 50% reduction in mSWAT score), without new tumors.
Time frame: Date of first dose through the earlier of last study visit or interim analysis data cut-off date of 12-Oct-2020, up to 16 months
Progression-free Survival (PFS)
Time from date of randomization until the date of earliest documented progression or death from any cause. The duration of PFS was censored at the date of the last mSWAT assessment if the subject was alive and had no documented progression. Disease progression in the skin is defined as ≥ 25% increase in mSWAT score from baseline or, in participants with complete or partial response, increase in mSWAT score of greater than the sum of the nadir plus 50% baseline score.
Time frame: Date of first dose through interim analysis data cut-off date of 12-Oct-2020, up to 16 months
Complete Response Rate
Percentage of subjects with a complete response in the skin based on mSWAT
Time frame: Date of first dose through interim analysis data cut-off date of 12-Oct-2020, up to 16 months
Time to Progression
Time from date of randomization until the earliest date of confirmed progression
Time frame: Date of first dose through interim analysis data cut-off date of 12-Oct-2020, up to 16 months
Time to Maximal Effect in mSWAT
Time to greatest improvement in mSWAT score
Time frame: Monthly from first dose through interim analysis data cut-off date of 12-Oct-2020, up to 16 months
Objective Response Rate in the Skin of at Least 28-days Duration (ORR1)
Percentage of participants achieving ≥ 50% improvement in mSWAT of at least 28-days duration
Time frame: Monthly from first dose through interim analysis data cut-off date of 12-Oct-2020, up to 16 months
Percentage of Subjects Achieving ≥ 50% Improvement in mSWAT at 28 Days
Percentage of subjects achieving ≥ 50% improvement from baseline in mSWAT at 28 days after first dose
Time frame: 28 days after first dose
Percentage of Subjects Achieving ≥ 50% Improvement in mSWAT at 4 Months
Percentage of subjects achieving ≥ 50% improvement from baseline in mSWAT at 4 months after first dose
Time frame: 4 months after first dose
Time to ≥ 50% Improvement in mSWAT
Time from date of randomization until ≥ 50% improvement in mSWAT score
Time frame: Monthly from first dose through interim analysis data cut-off date of 12-Oct-2020, up to 16 months
Duration of Response in Skin
Duration of response in skin (no progression after achieving ≥ 50% improvement in mSWAT)
Time frame: Monthly from first dose through interim analysis data cut-off date of 12-Oct-2020, up to 16 months
Pruritus Medication Utilization
Change from baseline in number of pruritus medications taken per subject
Time frame: Date of first dose through end of treatment or interim analysis data cut-off date of 12-Oct-2020, up to 16 months
Peak Plasma Concentration (Cmax) of Cobomarsen - First Dose
Peak plasma concentration (Cmax) of cobomarsen after first dose
Time frame: 1, 1.92, 6, 24 and 48 hours post-dose after the first dose
Peak Plasma Concentration (Cmax) of Cobomarsen - Week 5
Peak plasma concentration (Cmax) of cobomarsen after fourth dose (Week 5)
Time frame: 1, 1.92 and 6 hours post-dose after the Week 5 dose
Area Under the Plasma Concentration vs. Time Curve (AUC) of Cobomarsen - Week 5
Area under the curve (AUClast) for cobomarsen plasma concentration versus time curve after the fourth (Week 5) dose
Time frame: 1, 1.92 and 6 hours post-dose after the Week 5 dose
Number of Participants With Anti-drug Antibody Generation
Number of participants who develop antibodies to cobomarsen during treatment
Time frame: Date of first dose through interim analysis data cut-off date of 12-Oct-2020, up to 16 months
| Milestone | Cobomarsen (Randomized) | Vorinostat (Randomized) | Cobomarsen (Crossover) |
|---|---|---|---|
| Started | 19 | 18 | 0 |
| Completed | 4 | 8 | 0 |
| Not completed | 15 | 10 | 0 |
| Withdrew: Adverse event | 1 | 5 | 0 |
| Withdrew: Physician decision | 1 | 1 | 0 |
| Withdrew: Withdrawal by subject | 4 | 0 | 0 |
| Withdrew: Participant decision | 3 | 1 | 0 |
| Withdrew: Study terminated by sponsor | 6 | 3 | 0 |
| Milestone | Cobomarsen (Randomized) | Vorinostat (Randomized) | Cobomarsen (Crossover) |
|---|---|---|---|
| Started | 0 | 0 | 7 |
| Completed | 0 | 0 | 0 |
| Not completed | 0 | 0 | 7 |
| Withdrew: Physician decision | 0 | 0 | 2 |
| Withdrew: Sponsor decision to terminate trial | 0 | 0 | 5 |
ORR4 is the percentage of subjects with a complete response (CR) or partial response (PR) in the skin for 4 consecutive months confirmed by repeat assessments no less than 28 days (± 3 days) later. The modified Severity Weighted Assessment Tool (mSWAT) is used to measure skin disease severity based on the percentage of body surface area (BSA) with patches, plaques, or tumors. Total scores are calculated by multiplying the BSA percentage for each category of lesion (patch, plaque, or tumor) by a weighting factor and adding the three sub-scores. Lower scores indicate a lower degree of skin disease severity. CR corresponds to 100% clearance of skin lesions present at baseline (mSWAT score of 0). PR corresponds to 50-99% clearance of skin disease present at baseline (at least 50% reduction in mSWAT score), without new tumors.
| Percentage of participants | Cobomarsen (Randomized) | Vorinostat (Randomized) |
|---|---|---|
| Percentage of Subjects Achieving an Objective Skin Response of at Least 4 Months Duration (ORR4) | 15.8 | 16.7 |
Time from date of randomization until the date of earliest documented progression or death from any cause. The duration of PFS was censored at the date of the last mSWAT assessment if the subject was alive and had no documented progression. Disease progression in the skin is defined as ≥ 25% increase in mSWAT score from baseline or, in participants with complete or partial response, increase in mSWAT score of greater than the sum of the nadir plus 50% baseline score.
| months | Cobomarsen (Randomized) | Vorinostat (Randomized) |
|---|---|---|
| Progression-free Survival (PFS) | NA (9.26 to NA) | 6.01 (2.89 to 8.90) |
Percentage of subjects with a complete response in the skin based on mSWAT
| Percentage of participants | Cobomarsen (Randomized) | Vorinostat (Randomized) |
|---|---|---|
| Complete Response Rate | 0 | 5.6 |
Time from date of randomization until the earliest date of confirmed progression
| Months | Cobomarsen (Randomized) | Vorinostat (Randomized) |
|---|---|---|
| Time to Progression | NA (9.26 to NA) | 6.01 (2.89 to 8.90) |
Time to greatest improvement in mSWAT score
| Months | Cobomarsen (Randomized) | Vorinostat (Randomized) |
|---|---|---|
| Time to Maximal Effect in mSWAT | 4.5 ± 3.7 | 3.0 ± 2.7 |
Percentage of participants achieving ≥ 50% improvement in mSWAT of at least 28-days duration
| percentage of participants | Cobomarsen (Randomized) | Vorinostat (Randomized) |
|---|---|---|
| Objective Response Rate in the Skin of at Least 28-days Duration (ORR1) | 31.6 | 33.3 |
Percentage of subjects achieving ≥ 50% improvement from baseline in mSWAT at 28 days after first dose
| percentage of participants | Cobomarsen (Randomized) | Vorinostat (Randomized) |
|---|---|---|
| Percentage of Subjects Achieving ≥ 50% Improvement in mSWAT at 28 Days | 5.3 | 11.1 |
Percentage of subjects achieving ≥ 50% improvement from baseline in mSWAT at 4 months after first dose
| percentage of participants | Cobomarsen (Randomized) | Vorinostat (Randomized) |
|---|---|---|
| Percentage of Subjects Achieving ≥ 50% Improvement in mSWAT at 4 Months | 21.1 | 22.2 |
Time from date of randomization until ≥ 50% improvement in mSWAT score
| Months | Cobomarsen (Randomized) | Vorinostat (Randomized) |
|---|---|---|
| Time to ≥ 50% Improvement in mSWAT | 3.7 ± 2.7 | 2.7 ± 1.8 |
Duration of response in skin (no progression after achieving ≥ 50% improvement in mSWAT)
| Months | Cobomarsen (Randomized) | Vorinostat (Randomized) |
|---|---|---|
| Duration of Response in Skin | NA (NA to NA) | 7.85 (6.60 to NA) |
Change from baseline in number of pruritus medications taken per subject
| Number of pruritus medications | Cobomarsen (Randomized) | Vorinostat (Randomized) |
|---|---|---|
| Pruritus Medication Utilization | -1 ± 2.39 | -0.9 ± 1.35 |
Peak plasma concentration (Cmax) of cobomarsen after first dose
| µg/mL | Cobomarsen (Randomized) |
|---|---|
| Peak Plasma Concentration (Cmax) of Cobomarsen - First Dose | 10.5 ± 7.17 |
Peak plasma concentration (Cmax) of cobomarsen after fourth dose (Week 5)
| µg/mL | Cobomarsen (Randomized) |
|---|---|
| Peak Plasma Concentration (Cmax) of Cobomarsen - Week 5 | 9.34 ± 3.24 |
Area under the curve (AUClast) for cobomarsen plasma concentration versus time curve after the fourth (Week 5) dose
| µg*hr/mL | Cobomarsen (Randomized) |
|---|---|
| Area Under the Plasma Concentration vs. Time Curve (AUC) of Cobomarsen - Week 5 | 25.5 ± 6.27 |
Number of participants who develop antibodies to cobomarsen during treatment
No measurements were reported for this outcome.
Collected over All adverse events (AEs) that occurred from the time of informed consent through the last study visit, up to 18 months. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Cobomarsen (Randomized) | 0/19 (0%) | 2/19 (10.5%) | 18/19 (94.7%) |
| Vorinostat (Randomized) | 0/18 (0%) | 1/18 (5.6%) | 18/18 (100%) |
| Cobomarsen (Crossover) | 0/7 (0%) | 0/7 (0%) | 5/7 (71.4%) |
| Event | Cobomarsen (Randomized) | Vorinostat (Randomized) | Cobomarsen (Crossover) |
|---|---|---|---|
| Infusion related reactionInjury, poisoning and procedural complications | 0/19 | 1/18 | 0/7 |
| Skin infectionInfections and infestations | 1/19 | 0/18 | 0/7 |
| Superinfection of Skin LesionsInfections and infestations | 1/19 | 0/18 | 0/7 |
| Event | Cobomarsen (Randomized) | Vorinostat (Randomized) | Cobomarsen (Crossover) |
|---|---|---|---|
| DiarrhoeaGastrointestinal disorders | 7/19 | 8/18 | 1/7 |
| NauseaGastrointestinal disorders | 8/19 | 6/18 | 0/7 |
| FatigueGeneral disorders | 7/19 | 6/18 | 2/7 |
| PruritusSkin and subcutaneous tissue disorders | 7/19 | 4/18 | 0/7 |
| Muscle spasmsMusculoskeletal and connective tissue disorders | 2/19 | 6/18 | 0/7 |
| HypertensionVascular disorders | 3/19 | 5/18 | 2/7 |
| AlopeciaSkin and subcutaneous tissue disorders | 1/19 | 5/18 | 0/7 |
| HeadacheNervous system disorders | 5/19 | 1/18 | 0/7 |
| Skin infectionSkin and subcutaneous tissue disorders | 5/19 | 0/18 | 0/7 |
| Decreased appetiteMetabolism and nutrition disorders | 1/19 | 4/18 | 0/7 |
| Age, Categorical(Participants) | Cobomarsen | Vorinostat | Total |
|---|---|---|---|
| <=18 years | 0 | 0 | 0 |
| Between 18 and 65 years | 13 | 14 | 27 |
| >=65 years | 6 | 4 | 10 |
| Sex: Female, Male(Participants) | Cobomarsen | Vorinostat | Total |
|---|---|---|---|
| Female | 9 | 7 | 16 |
| Male | 10 | 11 | 21 |
| Ethnicity (NIH/OMB)(Participants) | Cobomarsen | Vorinostat | Total |
|---|---|---|---|
| Hispanic or Latino | 4 | 1 | 5 |
| Not Hispanic or Latino | 14 | 14 | 28 |
| Unknown or Not Reported | 1 | 3 | 4 |
| Race (NIH/OMB)(Participants) | Cobomarsen | Vorinostat | Total |
|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 |
| Asian | 0 | 1 | 1 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 0 | 1 | 1 |
| White | 17 | 13 | 30 |
| More than one race | 0 | 0 | 0 |
| Unknown or Not Reported | 2 | 3 | 5 |
| Region of Enrollment(participants) | Cobomarsen | Vorinostat | Total |
|---|---|---|---|
| Canada | 1 | 0 | 1 |
| Belgium | 2 | 3 | 5 |
| United States | 9 | 8 | 17 |
| Italy | 0 | 1 | 1 |
| United Kingdom | 4 | 2 | 6 |
| France | 1 | 3 | 4 |
| Spain | 2 | 1 | 3 |
| Skin tumor at screening(Participants) | Cobomarsen | Vorinostat | Total |
|---|---|---|---|
| Count of participants | 6 | 4 | 10 |
| No skin tumor at screening(Participants) | Cobomarsen | Vorinostat | Total |
|---|---|---|---|
| Count of participants | 13 | 14 | 27 |
| Lactate dehydrogenase (LDH) is greater than upper limit normal (ULN) at diagnosis(Participants) | Cobomarsen | Vorinostat | Total |
|---|---|---|---|
| Count of participants | 4 | 2 | 6 |
2 further baseline measures are reported on the registry.
Documents are hosted by the registry — open the source record to download them.
Plan to share: No
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miRagen Therapeutics, Inc.