Study of DPPG2-TSL-DOX Combined With Hyperthermia in Soft Tissue Sarcoma

Inclusion Criteria

• •1. Age at the time of consent ≥18 years.
• •2. Patient has provided written informed consent prior to any study-specific procedure.
• •3. Locally advanced (unresectable) or metastatic STS, including histological sarcoma subtypes treated as STS, for which treatment with DOX monotherapy is appropriate, as confirmed by the investigator.
• •4. Pretreatment with an anthracycline (including DOX, epirubicin as mono- or combination therapy). Patients who received anthracycline in an adjuvant setting are eligible.
• •5. Progressive disease not suitable for surgery after
• •1. only one further line of chemotherapy (including TKI) if the RHT field targets the clinically relevant tumor manifestation/s (e.g., locally advanced or multifocal intraabdominal STS; diffuse metastatic STS in which RHT of a tumor manifestation \[e.g., liver\] is considered relevant although other systemic metastases are present that do not endanger the patient, as per the judgment of the investigator), or
• •2. two or more further lines of chemotherapies (including TKI) for patients with metastatic STS and a tumor manifestation suitable for RHT.
• •6. All previous oncological treatments must have been completed ≥3 weeks (21 days) prior to the first dose of study treatment, ensuring a sufficient washout period.
• •7. Measurable disease as defined by the Response Evaluation Criteria in Solid Tumors (RECIST 1.1) (Eisenhauer et al. 2009).
• •8. Tumor accessible for RHT.
• •9. Left ventricular ejection fraction (LVEF) \>50% (within 28 days prior to enrolment).
• •10. Adequate hematologic, organ and coagulation function within 14 days prior to enrolment as assessed by local lab:
• •1. Absolute neutrophil count (ANC) ≥1.5×10\^9/L. Granulocyte-colony stimulating factor (G-CSF) cannot be administered within 2 weeks (14 days) prior to enrolment.
• •2. Platelet count ≥100×10\^9/L.
• •3. Hemoglobin ≥9.0 g/dL. No transfusions are allowed within 2 weeks (14 days) prior to enrolment.
• •4. Serum creatinine ≤1.5 times upper limit of normal (ULN).
• •5. Negative dipstick for proteinuria or if proteinuria ≥2+ (equals ≥ 1001 mg/L or 1.001 g/L (Lamb, et al., 2009), then additional 24 h urine collection \<1g protein/ 24 h.
• •6. Total bilirubin within ULN (except for patients with Gilbert's syndrome, who must have a total bilirubin \<3 mg/dL).
• •7. ALT/ AST ≤3.0×ULN; if the liver has tumor involvement, AST and ALT ≤5.0×ULN are acceptable.
• •8. An adequate coagulation function as defined by international normalized ratio (INR) ≤1.5×ULN or prothrombin time ≤1.5×ULN, and partial thromboplastin time ≤1.5×ULN (unless receiving anticoagulant therapy). Patients receiving phenprocoumon are recommended to switch to low molecular weight heparin and should have achieved stable coagulation status prior to the first dose of study treatment.
• •11. Tubular excretion rate (TER) by MAG-3-clearance ≥ TERLoLi (TERLoLi = 70% TERNorm).
• •12. Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2 (Appendix 1).
• •13. If female, must:
• •1. Be not of child-bearing potential due to surgical sterilization (at least 6 weeks following surgical bilateral oophorectomy with or without hysterectomy or tubal ligation) confirmed by medical history or menopause.
• •2. Be a post-menopausal woman, defined as a woman meeting either of the following criteria:
• •i. spontaneous amenorrhea for at least 12 months, not induced by a medical condition such as anorexia nervosa and not taking medications during the amenorrhea that induced the amenorrhea (for example, oral contraceptives, hormones, gonadotropin-releasing hormone, antiestrogens, selective estrogen receptor modulators \[SERMs\], or chemotherapy) ii. spontaneous amenorrhea for 6 to 12 months and a follicle-stimulating hormone level \>40 mIU/mL.
• •14. Women of childbearing potential (WOCBP; for a definition see Appendix 2) and men able to father a child must be ready and able to use two medically acceptable methods of birth control per ICH M3 (R2) that result in a low failure rate of less than 1% per year when used consistently and correctly beginning at screening, during trial participation, and until 6 months after last dose of study treatment. Also, partner of male participants, who is of childbearing potential must use a highly effective method of contraception during the same duration (Please refer to Appendix 2 for methods of highly effective contraception). A list of contraception methods meeting these criteria is provided in the patient information.
• •15. At least 3 months' life expectancy in the investigator's assessment.