Description:
BACKGROUND:
- Wee1 is a tyrosine kinase involved in the phosphorylation and inactivation of
cyclin-dependent kinase 1 (CDK1/CDC2)-bound cyclin B, resulting in G2 cell cycle arrest
in response to deoxyribonucleic acid (DNA) damage to allow time for DNA repair. Recent
preclinical data additionally implicates Wee1 in maintenance of genomic integrity during
S phase.
- Adavosertib (AZD1775) is a selective inhibitor of Wee1 kinase. Recent preclinical model
data additionally show single agent anti-tumor activity in multiple cancer cell lines
and tumor xenografts.
- Preliminary data show AZD1775 is tolerable at lower doses in combination with
chemotherapeutic agents. We propose to demonstrate single-agent activity for AZD1775.
PRIMARY OBJECTIVE:
- To establish the safety and tolerability of single-agent AZD1775 in patients with
refractory solid tumors
- To determine the pharmacokinetics of AZD1775 in patients with refractory solid tumors
SECONDARY OBJECTIVES:
- To determine the effect of AZD1775 on markers of DNA damage and apoptosis in tumor
tissue and circulating tumor cells
- To evaluate the antitumor activity of AZD1775 in patients with refractory solid tumors
EXPLORATORY OBJECTIVES:
-To identify tumor genomic alterations and gene expression patterns potentially associated
with AZD1775 antitumor activity
ELIGIBILITY:
- Patients must have histologically confirmed solid tumors for which all standard therapy
known to prolong survival have failed, or for which standard therapies do not exist.
- No major surgery, radiation, or chemotherapy within 3 weeks or (5 half-lives, whichever
is shorter) prior to entering the study.
- Adequate organ function
STUDY DESIGN:
- This study will follow a traditional 3+3 design.
- In Arm A starting at dose level 1, AZD1775 will be administered orally, twice a day
(BID), for 5 doses (Day (D) 1-3) during each cycle. Starting at dose level 2 and
onwards, AZD1775 will be administered orally, BID, for 5 doses for the first 2 weeks of
each cycle (D1-3 and 8- 10). Each cycle is 21 days (+/- 1 day for scheduling).
- Once maximum tolerated dose (MTD) is established, 6 additional patients will be enrolled
at the MTD to further evaluate that dose for pharmacokinetics (PK) and pharmacodynamics
(PD) endpoints.
- A further expansion arm of 6 additional patients with documented tumors harboring breast
cancer type 1 or 2 (BRCA)-1 or -2 mutations will also be enrolled at the MTD to further
explore the safety of the agent and obtain preliminary evidence of activity in this
patient population.
- Based on preliminary evidence of drug activity in an alternative once-daily dosing
schedule, patients without a documented BRCA mutation will be accrued to a once-daily
dosing schedule Arm B, with mandatory paired tumor biopsies at the maximum tolerated
single daily dose, to further evaluate PD endpoints. AZD1775 will be administered orally
once daily for 5 days (D1-5 and 8-12) during weeks 1 and 2 of each 21-day cycle (+/- 1
day for scheduling).
- During the escalation phase, tumor biopsies will be optional and will be evaluated for
pharmacodynamic (PD) studies for evidence of Wee1 inhibition DNA damage and repair, and
apoptosis (gamma H2A histone family member X (yH2AX), phosphorylated Nbs1 (pNbs1),
Rad51, Rabbit polyclonal phospho-cyclin-dependent kinases (pTyr15-Cdk) and caspase 3).
During the expansion phase, once MTD is reached, mandatory paired tumor biopsies will be
pursued in up to 20 additional patients enrolled at the MTD to further evaluate PD
endpoints.
Title
- Brief Title: AZD1775 for Advanced Solid Tumors
- Official Title: A Phase I Study of Single-agent AZD1775 (MK-1775), a Wee1 Inhibitor, in Patients With Advanced Refractory Solid Tumors
Clinical Trial IDs
- ORG STUDY ID:
130032
- SECONDARY ID:
13-C-0032
- NCT ID:
NCT01748825
Conditions
Interventions
Drug | Synonyms | Arms |
---|
MK-1775 (AZD1775) | Adavosertib | ARM 1 AZD1775 200 mg Once Daily |
Purpose
BACKGROUND:
- Wee1 is a tyrosine kinase involved in the phosphorylation and inactivation of
cyclin-dependent kinase 1 (CDK1/CDC2)-bound cyclin B, resulting in G2 cell cycle arrest
in response to deoxyribonucleic acid (DNA) damage to allow time for DNA repair. Recent
preclinical data additionally implicates Wee1 in maintenance of genomic integrity during
S phase.
- Adavosertib (AZD1775) is a selective inhibitor of Wee1 kinase. Recent preclinical model
data additionally show single agent anti-tumor activity in multiple cancer cell lines
and tumor xenografts.
- Preliminary data show AZD1775 is tolerable at lower doses in combination with
chemotherapeutic agents. We propose to demonstrate single-agent activity for AZD1775.
PRIMARY OBJECTIVE:
- To establish the safety and tolerability of single-agent AZD1775 in patients with
refractory solid tumors
- To determine the pharmacokinetics of AZD1775 in patients with refractory solid tumors
SECONDARY OBJECTIVES:
- To determine the effect of AZD1775 on markers of DNA damage and apoptosis in tumor
tissue and circulating tumor cells
- To evaluate the antitumor activity of AZD1775 in patients with refractory solid tumors
EXPLORATORY OBJECTIVES:
-To identify tumor genomic alterations and gene expression patterns potentially associated
with AZD1775 antitumor activity
ELIGIBILITY:
- Patients must have histologically confirmed solid tumors for which all standard therapy
known to prolong survival have failed, or for which standard therapies do not exist.
- No major surgery, radiation, or chemotherapy within 3 weeks or (5 half-lives, whichever
is shorter) prior to entering the study.
- Adequate organ function
STUDY DESIGN:
- This study will follow a traditional 3+3 design.
- In Arm A starting at dose level 1, AZD1775 will be administered orally, twice a day
(BID), for 5 doses (Day (D) 1-3) during each cycle. Starting at dose level 2 and
onwards, AZD1775 will be administered orally, BID, for 5 doses for the first 2 weeks of
each cycle (D1-3 and 8- 10). Each cycle is 21 days (+/- 1 day for scheduling).
- Once maximum tolerated dose (MTD) is established, 6 additional patients will be enrolled
at the MTD to further evaluate that dose for pharmacokinetics (PK) and pharmacodynamics
(PD) endpoints.
- A further expansion arm of 6 additional patients with documented tumors harboring breast
cancer type 1 or 2 (BRCA)-1 or -2 mutations will also be enrolled at the MTD to further
explore the safety of the agent and obtain preliminary evidence of activity in this
patient population.
- Based on preliminary evidence of drug activity in an alternative once-daily dosing
schedule, patients without a documented BRCA mutation will be accrued to a once-daily
dosing schedule Arm B, with mandatory paired tumor biopsies at the maximum tolerated
single daily dose, to further evaluate PD endpoints. AZD1775 will be administered orally
once daily for 5 days (D1-5 and 8-12) during weeks 1 and 2 of each 21-day cycle (+/- 1
day for scheduling).
- During the escalation phase, tumor biopsies will be optional and will be evaluated for
pharmacodynamic (PD) studies for evidence of Wee1 inhibition DNA damage and repair, and
apoptosis (gamma H2A histone family member X (yH2AX), phosphorylated Nbs1 (pNbs1),
Rad51, Rabbit polyclonal phospho-cyclin-dependent kinases (pTyr15-Cdk) and caspase 3).
During the expansion phase, once MTD is reached, mandatory paired tumor biopsies will be
pursued in up to 20 additional patients enrolled at the MTD to further evaluate PD
endpoints.
Detailed Description
BACKGROUND:
- Wee1 is a tyrosine kinase involved in the phosphorylation and inactivation of
cyclin-dependent kinase 1 (CDK1/CDC2)-bound cyclin B, resulting in G2 cell cycle arrest
in response to deoxyribonucleic acid (DNA) damage to allow time for DNA repair. Recent
preclinical data additionally implicates Wee1 in maintenance of genomic integrity during
S phase.
- Adavosertib (AZD1775) is a selective inhibitor of Wee1 kinase. Recent preclinical model
data additionally show single agent anti-tumor activity in multiple cancer cell lines
and tumor xenografts.
- Preliminary data show AZD1775 is tolerable at lower doses in combination with
chemotherapeutic agents. We propose to demonstrate single-agent activity for AZD1775.
PRIMARY OBJECTIVE:
- To establish the safety and tolerability of single-agent AZD1775 in patients with
refractory solid tumors
- To determine the pharmacokinetics of AZD1775 in patients with refractory solid tumors
SECONDARY OBJECTIVES:
-To evaluate the antitumor activity of AZD1775 in patients with refractory solid tumors
EXPLORATORY OBJECTIVES:
-To determine the effect of AZD1775 on markers of DNA damage and apoptosis in tumor
tissue and circulating tumor cells
- To assess whether sufficient Wee1 inhibition is maintained throughout the therapeutic
regimen
- To identify tumor genomic alterations and gene expression patterns potentially
associated withAZD1775 antitumor activity
ELIGIBILITY:
- Patients must have histologically confirmed solid tumors for which all standard therapy
known to prolong survival have failed, or for which standard therapies do not exist.
- No major surgery, radiation, or chemotherapy within 3 weeks or (5 half-lives, whichever
is shorter) prior to entering the study.
- Adequate organ function
STUDY DESIGN:
- This study will follow a traditional 3+3 design.
- In Arm A starting at dose level 1, AZD1775 will be administered orally, twice a day
(BID), for 5 doses (D1-3) during each cycle. Starting at dose level 2 and onwards,
AZD1775 will be administered orally, BID, for 5 doses for the first 2 weeks of each
cycle (D1-3 and 8- 10). Each cycle is 21 days (+/- 1 day for scheduling).
- Once maximum tolerated dose (MTD) is established, 6 additional patients will be enrolled
at the MTD to further evaluate that dose for pharmacokinetics (PK) and pharmacodynamics
(PD) endpoints.
- A further expansion arm of 6 additional patients with documented tumors harboring breast
cancer type 1 or 2 (BRCA)-1 or -2 mutations will also be enrolled at the MTD to further
explore the safety of the agent and obtain preliminary evidence of activity in this
patient population.
- Based on preliminary evidence of drug activity in an alternative once-daily dosing
schedule, patients without a documented BRCA mutation will be accrued to a once-daily
dosing schedule Arm B, with mandatory paired tumor biopsies at the maximum tolerated
single daily dose, to further evaluate PD endpoints. AZD1775 will be administered orally
once daily for 5 days (D1-5 and 8-12) during weeks 1 and 2 of each 21-day cycle (+/- 1
day for scheduling).
- During the escalation phase, tumor biopsies will be optional and will be evaluated for
pharmacodynamic (PD) studies for evidence of Wee1 inhibition DNA damage and repair, and
apoptosis (gamma H2A histone family member X (yH2AX), phosphorylated Nbs1 (pNbs1),
Rad51, Rabbit polyclonal phospho-cyclin-dependent kinases (pTyr15-Cdk) and caspase 3).
During the expansion phase, once MTD is reached, mandatory paired tumor biopsies will be
pursued in up to 20 additional patients enrolled at the MTD to further evaluate PD
endpoints.
Trial Arms
Name | Type | Description | Interventions |
---|
ARM 1 AZD1775 200 mg Once Daily | Experimental | | |
ARM 2 AZD1775 225 mg Once Daily | Experimental | | |
ARM 3 AZD1775 225 mg Twice Daily | Experimental | | |
ARM 4 AZD1775 225 mg Twice Daily (week 1-only dosing) | Experimental | | |
ARM 5 AZD1775 250 mg Once Daily | Experimental | | |
ARM 6 AZD1775 300 mg Once Daily | Experimental | | |
ARM 7 AZD1775 300 mg Twice Daily | Experimental | | |
ARM 8 AZD1775 400 mg Once Daily | Experimental | | |
ARM 9 Expansion Cohort 1: AZD1775 225 mg Twice Daily | Experimental | | |
ARM 10 Expansion Cohort 2: AZD1775 300 mg Once Daily | Experimental | | |
Eligibility Criteria
- ELIGIBILITY CRITERIA:
- Patients must have histologically confirmed solid tumors for which all standard
therapy known to prolong survival have failed or for which standard therapies do not
exist.
- Patients must have measurable disease or evaluable disease for the escalation phase;
for the 6 additional patients enrolled at maximum tolerated dose (MTD) for further
evaluation of pharmacokinetics (PK) and pharmacodynamics (PD) endpoints (Expansion
Cohort A). For the 6-patient breast cancer gene (BRCA)-mutation expansion cohort,
patients must have measurable disease; however, tumor biopsies are optional. For
Expansion Cohort B, patients must have tumor amenable to biopsy (excisional or
incision biopsies of skin or head (H) & neck (N) lesions under visualization) and
willingness to undergo a tumor biopsy or patient will be undergoing a procedure due to
medical necessity during which the tissue may be collected, or tumor biopsy tissue
from a previous research study or medical care is available for submission at
registration. Criteria for the submission of tissue are:
- Tissue must have been collected within 3 months prior to registration
- Patient has not received any intervening therapy for their cancer since the
collection of the tumor sample
- Tumor tissue must meet the minimum requirements
- Patients must have completed any chemotherapy, radiation therapy, surgery, or biologic
therapy greater than or equal to 3 weeks (or > 5 half-lives, whichever is shorter)
prior to entering the study. Patients must be greater than or equal to 2 weeks since
any prior administration of a study drug in an exploratory Investigational New Drug
(IND)/Phase 0 study or more than or equal to 1 week from palliative radiation therapy.
Patients must have recovered to eligibility levels from prior toxicity or adverse
events.
- Age greater than or equal to 18 years of age.
- Eastern Cooperative Oncology Group (ECOG) performance status less than or equal to 1
(Karnofsky >60%)
- Life expectancy of greater than 3 months.
- Patients must have normal organ and marrow function as defined below:
- leukocytes greater than or equal to 3,000/mcL
- absolute neutrophil count greater than or equal to 1,500/mcL
- platelets greater than or equal to 100,000/mcL
- hemoglobin >9 g/dL
- total bilirubin less than or equal to 1.5 times institutional upper limit of
normal
- Aspartate aminotransferase (AST) serum glutamic-oxaloacetic transaminase
(SGOT)/alanine aminotransferase (ALT) serum glutamate-pyruvate transaminase
(SGPT) less than or equal to 3 times institutional upper limit of normal
- creatinine less than or equal to 1.5 times institutional upper limit of normal OR
- creatinine clearance greater than or equal to 60 mL/min/1.73 m(2) for patients
with creatinine levels above institutional normal.
- The effects of Adavosertib (AZD1775) on the developing human fetus are unknown. For
this reason and because molecular inhibitors of Wee1 kinase are known to be
teratogenic, women of child-bearing potential (WoCBP) may be included only if
acceptable contraception is in place for two weeks before study entry, for the
duration of the treatment with the study drug, and for 2 months after the last dose of
AZD1775. Male patients who are involved in the study must agree to avoid procreative
and unprotected sex (i.e., by using acceptable forms of contraception) and must not
donate sperm during the study and for 3 months after the last dose of AZD1775. Where
the female partner is pregnant or not using effective birth control, men should be
advised to abstain while in the study and for 3 months after the last dose of AZD1775.
Female partners, who are of child-bearing potential, of men participating in clinical
studies of AZD1775 will also be required to use effective contraceptive measures while
their partner is on study drug and for 3 months thereafter. Male patients will be
advised to arrange for the freezing of sperm samples prior to the start of the study
should they wish to father children while on AZD1775 or during the 3 months after
stopping AZD1775.
- Because there is an unknown but potential risk for adverse events in nursing infants
secondary to treatment of the mother with the study drugs, breastfeeding should be
discontinued prior to the first of study drug and women should refrain from nursing
throughout the treatment period and for 14 days following the last dose of study drug.
- Patients must be able to swallow whole tablets or capsules. Nasogastric or G-tube
administration is not allowed. Any gastrointestinal disease which would impair ability
to swallow, retain, or absorb drug is not allowed.
- Ability to understand and the willingness to sign a written informed consent document.
- Patients with prostate cancer can continue to receive treatment with
gonadotropin-releasing hormone (GnRH) agonists while on study, as long as there is
evidence of disease progression on therapy.
EXCLUSION CRITERIA:
- Patients who are receiving any other investigational agents.
- Patients with known active brain metastases or carcinomatous meningitis are excluded
from this clinical trial. Patients whose brain metastatic disease status has remained
stable for greater than or equal to 4 weeks following treatment of brain metastases
are eligible to participate at the discretion of the principal investigator.
- Eligibility of subjects receiving any medications or substances with the potential to
affect the activity or pharmacokinetics of AZD1775 will be determined following review
by the principal investigator.
- Patients receiving any medications or substances that are inhibitors or inducers of
Cytochrome P450 3A4 (CYP3A4), or CYP3A4 substrates need to be reviewed by the
principal investigator. Continuation of such medications will be at the discretion of
the principal investigator. Concomitant use of aprepitant or fosaprepitant is
prohibited. As grapefruit and Seville oranges are known to contain moderate inhibitors
of CYP3A4, these fruits or their products (including marmalade, juice, etc.) should be
avoided while taking AZD1775. The use of sensitive substrates of CYP3A4, such as
atorvastatin, simvastatin and lovastatin, is also prohibited in this study. Herbal
preparations are not allowed throughout the study. These herbal medications include
but are not limited to: St. John's wort, kava, ephedra (mahung), gingko biloba,
dehydroepiandrosterone (DHEA), yohimbe, saw palmetto and ginseng.
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
arrhythmia, or psychiatric illness/social situations that would limit compliance with
study requirements.
- Pregnant women are excluded from this study because the effects of the study drugs on
the developing fetus are unknown.
- Human immunodeficiency virus (HIV) positive patients on antiretroviral therapy are
ineligible because of the potential for pharmacokinetics (PK) interactions.
INCLUSION OF WOMEN AND MINORITIES:
Both men and women of all races and ethnic groups are eligible for this trial.
Maximum Eligible Age: | 120 Years |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | To Establish the Safety and Tolerability of Single-agent AZD1775 in Patients With Refractory Solid Tumors |
Time Frame: | Date treatment consent signed to date off study, approx.19 mo/8 d for A1, 3 mo/28 d for A2, 10 mo/28 d for A3, 2 mo/14 d for A4, 20 mo/24 d for A5, 10 mo/23 d for A6, 4 mo/23 d for A7, 14 mo/11 d for A8, 15 mo/24 d for A9, and 77 mo/6 d for A10. |
Safety Issue: | |
Description: | Here is the number of participants with serious and non-serious adverse events assessed by the Common Terminology Criteria for Adverse Events (CTCAE v4.0). A non-serious adverse event is any untoward medical occurrence. A serious adverse event is an adverse event or suspected adverse reaction that results in death, a life-threatening adverse drug experience, hospitalization, disruption of the ability to conduct normal life functions, congenital anomaly/birth defect or important medical events that jeopardize the patient or subject and may require medical or surgical intervention to prevent one of the previous outcomes mentioned. |
Secondary Outcome Measures
Measure: | To Evaluate the Antitumor Activity of AZD1775 in Patients With Refractory Solid Tumors |
Time Frame: | 21 days |
Safety Issue: | |
Description: | Objective Response is defined as a Complete Response + Partial Response and was assessed by the Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. Complete Response (CR) is disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to <10 mm. Partial Response (PR) is at least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum of diameters. |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Completed |
Lead Sponsor: | National Cancer Institute (NCI) |
Trial Keywords
- AZD1775
- Adavosertib
- MK-1775
- Refractory
- Solid Tumors
- Wee1 Inhibitor
- Tyrosine Kinase
Last Updated
July 26, 2021