Clinical Trials /

BKM120 Combined With Vemurafenib (PLX4032) in BRAFV600E/K Mutant Advanced Melanoma

NCT01512251

Description:

This is a phase 1/2 clinical trial with the goal of determining whether the addition of the investigational agent BKM120 to vemurafenib will lead to improved 6-month progression-free survival in patients with BRAFV600E/K mutant melanoma.

Related Conditions:
  • Melanoma
Recruiting Status:

Completed

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: BKM120 Combined With Vemurafenib (PLX4032) in BRAFV600E/K Mutant Advanced Melanoma
  • Official Title: A Phase 1/2 Trial of BKM120 Combined With Vemurafenib (PLX4032) in BRAFV600E/K Mutant Advanced Melanoma (Novartis Study Number CBKM120ZUS21T)

Clinical Trial IDs

  • ORG STUDY ID: 11952
  • SECONDARY ID: CBKM120ZUS21T
  • NCT ID: NCT01512251

Conditions

  • BRAF Mutant Metastatic Melanoma

Interventions

DrugSynonymsArms
BKM120 Combined with Vemurafenib (PLX4032)No Previous Treatment

Purpose

This is a phase 1/2 clinical trial with the goal of determining whether the addition of the investigational agent BKM120 to vemurafenib will lead to improved 6-month progression-free survival in patients with BRAFV600E/K mutant melanoma.

Detailed Description

      The phase 1 portion of this trial is a dose escalation study; the phase 2 portion is a
      single-stage, single arm prospective clinical trial. All patients will receive continuous
      doses of vemurafenib twice a day and BKM120 once a day.

      In the phase 1 portion of the study, there will be a 7 day lead-in period to allow for single
      dose pharmacokinetic analysis of BKM120 alone. Cycle 1 (28 days) is the dose-limiting
      toxicity (DLT) period. During phase 1, vemurafenib and BKM120 doses will be escalated using a
      standard 3+3 dose escalation scheme with the goal of identifying the recommended phase 2
      dose.

      In the phase 2 portion of the study, patients will receive continuous doses of vemurafenib
      and BKM120 starting on day 1 of the first cycle. In the phase 2 portion of the study,
      patients will receive vemurafenib and BKM120 at the recommended phase 2 dose.
    

Trial Arms

NameTypeDescriptionInterventions
No Previous TreatmentOther150 mg oral dabrafenib twice a day until disease progression, death, or unacceptable adverse events.
  • BKM120 Combined with Vemurafenib (PLX4032)

Eligibility Criteria

        Inclusion Criteria

          1. Histologically or cytologically confirmed diagnosis of unresectable stage III and
             stage IV melanoma

          2. BRAFV600E or BRAFV600K mutation-positive

          3. Age >= 18 years

          4. Eastern Cooperative Oncology Group (ECOG) performance status <= 2

          5. Patients must have at least one site of measurable disease (per RECIST for solid
             tumors)

          6. Life expectancy of ≥ 12 weeks

          7. Adequate bone marrow function as shown by: Absolute Neutrophil Count (ANC) >= 1.5 x
             109/L, Platelets >= 100 x 109/L, Hb >9 g/dL

          8. Total calcium (corrected for serum albumin) within normal limits (biphosphonate use
             for malignant hypercalcemia control is not allowed)

          9. Magnesium ≥ the lower limit of normal

         10. Potassium within normal limits for the institution

         11. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) within normal
             range (or <= 3.0 x upper limit of normal (ULN) if liver metastases are present)

         12. Serum bilirubin within normal range (or <= 1.5 x ULN if liver metastases are present;
             or total bilirubin <= 3.0 x ULN with direct bilirubin within normal range in patients
             with well documented Gilbert Syndrome)

         13. Serum creatinine <= 1.5 x ULN or 24-hour clearance >= 50 mL/min

         14. Serum amylase <= ULN

         15. Serum lipase <= ULN

         16. International Normalized Ratio (INR) <= 2

         17. Fasting plasma glucose <= 120 mg/dL (6.7 mmol/L)

         18. Negative serum pregnancy test within 48 hours before starting study treatment

        Exclusion Criteria

          1. Patients who have received prior treatment with a PI3K inhibitor or a BRAF inhibitor,
             prior treatment with sorafenib is permitted.

          2. Patients with a known hypersensitivity to BKM120 or to its excipients

          3. Patients with untreated brain metastases are excluded; however, patients with
             metastatic central nervous system (CNS) tumors may participate in this trial, if the
             patient is > 4 weeks from therapy completion (incl. radiation and/or surgery) and
             clinically stable at the time of study entry

          4. Patients with acute or chronic liver, renal disease or pancreatitis

          5. Patients with the following mood disorders as judged by the Investigator or a
             psychiatrist, or as a result of patient's mood assessment questionnaire:

               -  Medically documented history of or active major depressive episode, bipolar
                  disorder (I or II), obsessive-compulsive disorder, schizophrenia, history of
                  suicidal attempt or ideation, or homicidal ideation

               -  >= CTCAE grade 3 anxiety

               -  Meets the cut-off score of >= 10 in the Patient Health Questionnaire-9 (PHQ-9) or
                  a cut-off of >= 15 in the General Anxiety Disorder-7 (GAD-7) mood scale,
                  respectively, or selects a positive response of "1, 2, or 3" to question number 9
                  regarding potential for suicidal thoughts in the PHQ-9 (independent of the total
                  score of the PHQ-9) will be excluded from the study unless overruled by the
                  psychiatric assessment

          6. Patients with diarrhea >= CTCAE grade 2

          7. Patient has active cardiac disease including any of the following:

               -  Left ventricular ejection fraction (LVEF) < 50% as determined by multigated
                  acquisition (MUGA) or echocardiogram (ECHO)

               -  QTc > 480 msec on screening ECG (using the QTcF formula)

               -  Personal or family history of prolonged QT syndrome

               -  Angina pectoris that requires the use of anti-anginal medication

               -  Ventricular arrhythmias except for benign premature ventricular contractions

               -  Supraventricular and nodal arrythmias requiring a pacemaker or not controlled
                  with medication

               -  Conduction abnormality requiring a pacemaker

               -  Symptomatic pericarditis

          8. Patient has a history of cardiac dysfunction including any of the following:

               -  Myocardial infarction within the last 6 months, documented by persistent elevated
                  cardiac enzymes or persistent regional wall abnormalities on assessment of left
                  ventricular ejection fraction (LVEF) function

               -  History of documented congestive heart failure (New York Heart Association
                  functional classification III-IV)

               -  Documented cardiomyopathy

          9. Poorly controlled diabetes mellitus (HbA1c > 8 %)

         10. Other concurrent severe and/or uncontrolled concomitant medical conditions that could
             cause unacceptable safety risks or compromise compliance with the protocol

             - Significant symptomatic deterioration of lung function; if clinically indicated,
             pulmonary function tests including measures of predicted lung volumes, Diffusing
             capacity of the lungs for carbon monoxide (DLCO), oxygen (O2) saturation at rest on
             room air should be considered to exclude pneumonitis or pulmonary infiltrates

         11. Impairment of gastrointestinal (GI) function or GI disease that may significantly
             alter the absorption of BKM120 (e.g., ulcerative diseases, uncontrolled nausea,
             vomiting, diarrhea, malabsorption syndrome, or small bowel resection)

         12. Patients who have been treated with any hematopoietic colony-stimulating growth
             factors (e.g., Granulocyte colony-stimulating factor (G-CSF), Granulocyte-macrophage
             colony-stimulating factor (GM-CSF)) <= 2 weeks prior to starting study drug;
             erythropoietin or darbepoetin therapy, if initiated at least 2 weeks prior to
             enrollment, may be continued

         13. Patients who are currently receiving treatment with medication with a known risk to
             prolong the QT interval or inducing Torsades de Pointes and the treatment cannot
             either be discontinued or switched to a different medication prior to starting study
             drug

         14. Patients receiving chronic treatment with steroids or another immunosuppressive agent;
             topical applications, inhaled sprays, eye drops or local injections are allowed;
             patients with previously treated brain metastases, who are on stable low dose
             corticosteroids treatment for at least 14 days before start of study treatment are
             eligible

         15. Patients who have taken herbal medications and certain fruits within 7 days prior to
             starting study drug - herbal medications include, but are not limited to St. John's
             Wort, Kava, ephedra (ma huang), gingko biloba, dehydroepiandrosterone (DHEA), yohimbe,
             saw palmetto, and ginseng; fruits include CYP3A inhibitors: Seville oranges,
             grapefruit, pomelos, or exotic citrus fruits

         16. Patients who are currently treated with drugs known to be moderate and strong
             inhibitors or inducers of isoenzyme CYP3A, and the treatment cannot be discontinued or
             switched to a different medication prior to starting study drug; note that
             co-treatment with weak inhibitors of CYP3A is allowed).

         17. Patients who have received chemotherapy or targeted anticancer therapy <= 4 weeks (6
             weeks for nitrosourea, antibodies or mitomycin-C) prior to starting study drug must
             have resolution of treatment related adverse events to baseline or grade 1 before
             starting the trial

         18. Patients who have received wide field radiotherapy <= 4 weeks or limited field
             radiation for palliation ≤ 2 weeks prior to starting study drug or who have not
             recovered from side effects of such therapy

         19. Patients who have undergone major surgery <= 2 weeks prior to starting study drug or
             who have not recovered from side effects of such therapy

         20. Patients who are currently taking therapeutic doses of warfarin sodium or any other
             coumadin-derivative anticoagulant

         21. Women who are pregnant or breast feeding or adults of reproductive potential not
             employing an effective method of birth control; women of child-bearing potential must
             have a negative serum pregnancy test <= 72 hours prior to initiating treatment; double
             barrier contraceptives must be used through the trial by both sexes; oral,
             implantable, or injectable contraceptives are therefore not considered effective for
             this study

               -  Women are considered post-menopausal and not of child bearing potential if they
                  have had 12 months of natural (spontaneous) amenorrhea with an appropriate
                  clinical profile (e.g. age appropriate, history of vasomotor symptoms) or six
                  months of spontaneous amenorrhea with serum follicle stimulating hormone (FSH)
                  levels > 40 milli-international units per millilitre (mIU/mL) [for US only: and
                  estradiol < 20 pg/mL] or have had surgical bilateral oophorectomy (with or
                  without hysterectomy) at least six weeks ago. In the case of oophorectomy alone,
                  only when the reproductive status of the woman has been confirmed by follow up
                  hormone level assessment is she considered not of child bearing potential.

               -  Women of child-bearing potential, defined as all women physiologically capable of
                  becoming pregnant, must use highly effective contraception during treatment for 3
                  months in total after study drug discontinuation. Highly effective contraception
                  is defined as either: True abstinence-when this is in line with the preferred and
                  usual lifestyle of the subject, periodic abstinence and withdrawal are not
                  acceptable methods of contraception; Sterilization-have had surgical bilateral
                  oophorectomy (with or without hysterectomy) or tubal ligation at least six weeks
                  ago; Male partner sterilization-for female subjects, the vasectomised male
                  partner should be the sole partner for that patient; Use of a combination of any
                  two of the following barrier methods of contraception-condom or Occlusive cap
                  with spermicidal foam/gel/film/cream/vaginal suppository

               -  Fertile males, defined as all males physiologically capable of conceiving
                  offspring must use condom during treatment, for 3 months in total after study
                  drug discontinuation and should not father a child in this period

         22. Known diagnosis of human immunodeficiency virus (HIV) infection

         23. History of another malignancy within 3 years, except cured or curable basal cell
             carcinoma of the skin, squamous cell carcinoma of the skin, or carcinoma in situ of
             the cervix; patients with lesions curable by excision must have these lesions excised
             prior to the initiation of treatment on study

         24. Patient is unable or unwilling to abide by the study protocol or cooperate fully with
             the investigator
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Phase 1 - Safety & Recommended Phase 2 Dose (RP2D)
Time Frame:28 days
Safety Issue:
Description:RP2D determined by maximum tolerated dose (MTD), post-dose-limiting toxicity (DLT) period toxicity, and pharmacokinetic data

Secondary Outcome Measures

Measure:Secondary Outcome 1 Phase 2 - Objective Response Rate
Time Frame:Day 28 (+/- 3) of even-numbered treatment cycles until progression
Safety Issue:
Description:Objective response rate determined by tumor assessments, clinical tests and laboratory tests.
Measure:Secondary Outcome 2 Phase 2 - Safety and Tolerability
Time Frame:During study treatment, up to 2 years
Safety Issue:
Description:Determined by clinical and laboratory tests, and adverse events (AE) assessments
Measure:Secondary Outcome 3 Phase 2 - Phosphatase and TENsin (PTEN) Expression
Time Frame:No time limit
Safety Issue:
Description:PTEN expression associated with better PFS determined by laboratory tests.
Measure:Secondary Outcome 4 Phase 2 - Phosphatidylinositol 3-kinase (PI3K)-Pathway Signaling Reduction Levels
Time Frame:No time limit
Safety Issue:
Description:Greater reduction in PI3K-pathway signaling associated with better PFS determined by laboratory tests and tumor assessments.
Measure:Secondary Outcome 5 Phase 2 - PI3K Pathway Gene Expression Levels
Time Frame:No time limit
Safety Issue:
Description:Responding tumors lack gene expression signatures of PI3K pathway activation, and progressing tumors demonstrate gene expression signatures of PI3K pathway activation - determined by laboratory tests and tumor assessments.
Measure:Secondary Outcome 6 Phase 2 - MAPK Pathway Gene Expression Levels
Time Frame:No time limit
Safety Issue:
Description:Responding tumors lack gene expression signatures of MAPK pathway activation, and progressing tumors demonstrate gene expression signatures of MAPK pathway activation - determined by laboratory tests and tumor assessments.

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Completed
Lead Sponsor:University of California, San Francisco

Trial Keywords

  • BKM120
  • BRAF
  • Melanoma
  • PI3K

Last Updated

August 17, 2020