iExosomes in Treating Participants With Metastatic Pancreas Cancer With KrasG12D Mutation

PRIMARY OBJECTIVES:

I. To identify the maximum tolerated dose (MTD) of mesenchymal stem cell (MSC)-derived
exosomes loaded with small interference RNA (siRNA) against KrasG12D (iExosomes) in
metastatic pancreatic ductal adenocarcinoma (PDAC) patients with KrasG12D mutation.

II. To identify the dose-limiting toxicities (DLT) of mesenchymal stem cell (MSC)-derived
exosomes loaded with siRNA against KrasG12D (iExosomes) in metastatic PDAC patients with
KrasG12D mutation.

SECONDARY OBJECTIVES:

I. Evaluate the pharmacokinetic profile of iExosomes. II. Assess the overall response rate of
iExosomes in the chosen patient population.

III. Assess the disease control rate (partial response + stable disease) with therapy.

IV. Determine median progression-free survival (PFS) with this treatment. V. Determine the
median overall survival (OS) with this treatment.

EXPLORATORY OBJECTIVES:

I. Evaluate optional tissue collection and serum-derived exosomes and circulating-free
deoxyribonucleic acid (DNA) (cfDNA) for detection of DNA and ribonucleic acid (RNA) showing
KrasG12D sequence; evaluate DNA and RNA showing KrasG12D sequence in optional tissue
collection.

II. Evaluate the siRNA content in blood and optional tissue collection.

OUTLINE: This is a dose-escalation study.

Participants receive mesenchymal stromal cells-derived exosomes with KrasG12D siRNA
intravenously (IV) over 15-20 minutes on days 1, 4, and 10. Treatment repeats every 14 days
for up to 3 courses in the absence of disease progression or unacceptable toxicity.
Participants who respond may continue 3 additional courses.

After completion of study treatment, participants are followed up at 30 days, then every 3
months for up to 1 year.

Inclusion Criteria:

- Patients with histologically confirmed metastatic pancreatic ductal adenocarcinoma
harboring KrasG12D mutation

- Patients must have documented progression or stable disease on one or more lines of
systemic therapy. If stable disease, patient must have completed at least 4 months of
chemotherapy with cytotoxic therapy

- KrasG12D mutation status will be informed from any previous routine molecular
profiling (using commercial assays such as Foundation One, Caris, Oncomine or other)
of tissue or blood. Additional KrasG12D mutation status may be confirmed using tissue
biopsy or blood prior to enrolling into the trial

- ECOG (Eastern Cooperative Oncology Group) performance status of 0-1

- Absolute neutrophil count (ANC) more or equal to 1,500 cells/mm3

- Platelets more or equal to 100,000/ul

- Hemoglobin more than 9.0 g/dL

- Total bilirubin between 1 and 1.5 mg/dL

- AST (aspartate aminotransferase) and ALT (alanine transaminase) less than 2.5 x ULN
(upper limit of normal)

- Alkaline phosphatase less than 2.5 x ULN

- Creatinine less than 1.5 gm/dL

- In patients with known Gilbert's syndrome, direct bilirubin less or equal to 1.5 x ULN
will be used as organ function criteria, instead of total bilirubin

- Negative serum pregnancy test in women with childbearing potential (WOCBP) defined as
not post-menopausal for 12 months or no previous surgical sterilization, within one
week prior to initiation of treatment. WOCBP must be using an adequate method of
contraception to avoid pregnancy throughout the study and for up to 12 weeks after the
last dose of study drug to minimize the risk of pregnancy. WOCBP must be using an
adequate method of contraception to avoid pregnancy throughout the study and for up to
12 weeks after the last dose of study drug to minimize the risk of pregnancy

- A male subject of fathering potential must use an adequate method of contraception to
avoid conception throughout the study and for up to 12 weeks after the last dose of
study drug to minimize the risk of pregnancy. If the partner is pregnant or
breastfeeding, the subject must use a condom

- Patients must sign an informed consent and authorization indicating that they are
aware of the investigational nature of this study and the known risks involved

Exclusion Criteria:

- Concurrent severe and/or uncontrolled medical conditions which could compromise
participation in the study such as unstable angina, myocardial infarction within 6
months, unstable symptomatic arrhythmia, uncontrolled diabetes, serious active or
uncontrolled infection

- Pregnancy (positive pregnancy test) or lactation

- Known CNS (central nervous system) disease, except for treated brain metastasis.
Treated brain metastases are defined as having no evidence of progression or
hemorrhage after treatment and no ongoing requirement for dexamethasone, as
ascertained by clinical examination and brain imaging (magnetic resonance imaging-MRI
or computerized tomography-CT) during the screening period. Anticonvulsants (stable
dose) are allowed. Treatment for brain metastases may include whole brain radiotherapy
(WBRT), radiosurgery (RS; gamma knife, linear accelerator [LINAC], or equivalent) or a
combination as deemed appropriate by the treating physician. Patients with CNS
metastases treated by neurosurgical resection or brain biopsy performed within 3
months prior to day 1 will be excluded