Clinical Trials /

Ceritinib and Everolimus in Treating Patients With Locally Advanced or Metastatic Solid Tumors or Stage IIIB-IV Non-small Cell Lung Cancer

NCT02321501

Description:

This phase I trial studies the side effects and best dose of ceritinib and everolimus in treating patients with solid tumors that have spread from where they started to nearby tissue or lymph nodes (locally advanced) or to other places in the body (metastatic) or stage IIIB-IV non-small cell lung cancer. Ceritinib and everolimus may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.

Related Conditions:
  • Malignant Solid Tumor
  • Non-Small Cell Lung Carcinoma
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Ceritinib and Everolimus in Treating Patients With Locally Advanced or Metastatic Solid Tumors or Stage IIIB-IV Non-small Cell Lung Cancer
  • Official Title: A Phase I/Ib Dose Escalation and Biomarker Study of Ceritinib (LDK378) in Combination With Everolimus in Patients With Locally Advanced or Metastatic Solid Tumors With an Expansion in NSCLC Characterized by Abnormalities in Anaplastic Lymphoma Kinase (ALK) Expression

Clinical Trial IDs

  • ORG STUDY ID: 2014-0890
  • SECONDARY ID: NCI-2015-00062
  • SECONDARY ID: 2014-0890
  • SECONDARY ID: P30CA016672
  • NCT ID: NCT02321501

Conditions

  • ALK Positive
  • Locally Advanced Malignant Solid Neoplasm
  • Metastatic Malignant Solid Neoplasm
  • ROS1 Gene Rearrangement
  • Stage IIIB Lung Non-Small Cell Cancer AJCC v7
  • Stage IV Lung Non-Small Cell Cancer AJCC v7

Interventions

DrugSynonymsArms
CeritinibLDK 378, LDK378, ZykadiaTreatment (ceritinib, everolimus)
Everolimus42-O-(2-Hydroxy)ethyl Rapamycin, Afinitor, Certican, RAD 001, RAD001, Votubia, ZortressTreatment (ceritinib, everolimus)

Purpose

This phase I trial studies the side effects and best dose of ceritinib and everolimus in treating patients with solid tumors that have spread from where they started to nearby tissue or lymph nodes (locally advanced) or to other places in the body (metastatic) or stage IIIB-IV non-small cell lung cancer. Ceritinib and everolimus may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.

Detailed Description

      PRIMARY OBJECTIVE:

      I. To determine the maximum tolerated dose (MTD) of ceritinib (novel, potent and selective
      small molecule anaplastic lymphoma kinase [ALK] inhibitor) in combination with everolimus (a
      mammalian target of rapamycin [mTOR] inhibitor) in advanced cancers.

      SECONDARY OBJECTIVES:

      I. Preliminary descriptive assessment of the anti-tumor activity (response rate) of the
      combination in advanced non-small cell lung cancer (NSCLC) based upon Response Evaluation
      Criteria in Solid Tumors (RECIST) 1.1.

      II. To determine the pharmacokinetics of ceritinib and everolimus used in combination.

      III. To determine the safety of ceritinib and everolimus used in combination. IV. To evaluate
      the toxicities and tolerability of the combinations. V. To document anti-tumor activity
      (disease control rate at 8 weeks and progression-free survival).

      EXPLORATORY OBJECTIVES:

      I. To explore baseline molecular markers that may predict clinical activity, and to explore
      pharmacodynamic markers in blood, tumor tissue and molecular imaging that may predict an
      increase in apoptosis and clinical activity.

      II. To determine concordance of ALK (protein levels on immunohistochemistry, fusion detection
      by fluorescence in situ hybridization [FISH] and somatic mutations).

      III. To determine ribosomal protein S6 kinase (S6K) phosphorylation as a measure of mTOR
      inhibition.

      OUTLINE: This is a dose-escalation study.

      Patients receive ceritinib orally (PO) once daily (QD) and everolimus PO QD on days 1-28.
      Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.

      After completion of study treatment, patients are followed up for 28 days.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (ceritinib, everolimus)ExperimentalPatients receive ceritinib PO QD and everolimus PO QD on days 1-28. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
  • Ceritinib
  • Everolimus

Eligibility Criteria

        Inclusion Criteria:

          -  For dose escalation cohort: patients with histologically or cytologically confirmed
             locally advanced or metastatic solid tumors who have failed at least one line of
             therapy

          -  For dose expansion cohort: patients with stage IIIB or IV ALK + NSCLC who have failed
             at least one line of therapy and are progressing on an ALK inhibitor; for dose
             expansion, patients who have ROS1 rearrangement testing by either next generation
             sequencing (NGS) or fluorescence in situ hybridization (FISH) will be eligible

          -  Absolute neutrophil count (ANC) >= 1,500/microliter

          -  Platelets >= 100,000/microliter

          -  Hemoglobin (Hgb) >= 9 g/dL

          -  Creatinine =< 1.5 x upper limit of normal (ULN)

          -  Prothrombin time (PT), partial thromboplastin time (PTT) =< 1.5 x ULN

          -  Total bilirubin =< 1.5 x ULN

          -  Alanine transaminase (ALT) and aspartate aminotransferase (AST) < 1.5 x ULN (< 5 x ULN
             if patient has liver metastasis)

          -  Patient will have a tumor suitable for fine needle aspirates (FNA) or core biopsy for
             research purposes (2 or more FNAs if core is not feasible)

          -  Able to swallow oral medications

          -  Patient must have performance status =< 2 on the Eastern Cooperative Oncology Group
             (ECOG) performance scale

          -  Measurable disease by RECIST or evaluable disease (e.g., bone metastasis, or lesions
             which do not fulfill RECIST criteria for metastatic disease)

          -  ALK-positive NSCLC patients with asymptomatic central nervous system (CNS) metastases
             who are neurologically stable or have not required increasing doses of steroids within
             the 2 week prior to study entry to manage CNS symptoms

          -  Non-ALK-positive NSCLC patients with CNS metastasis should have completed a course of
             therapy would be eligible for the study provided they are clinically stable for 1
             month prior to entry as defined as: (1) no evidence of new or enlarging CNS metastasis
             (2) off steroids

          -  Negative serum or urine pregnancy test beta-human chorionic gonadotropin (beta hCG)
             within 2 weeks prior to receiving the first dose of study medication for women of
             childbearing age

          -  Patient must have completed any systemic therapy regimens (except an ALK inhibitor)
             and therapeutic radiation a minimum of 21 days prior to initiation of study therapy

          -  Fasting serum cholesterol =< 300 mg/dL OR =< 7.75 mmol/L AND fasting triglycerides =<
             2.5 x ULN; NOTE: in case one or both of these thresholds are exceeded, the patient can
             only be included after initiation of appropriate lipid lowering medication

          -  Signed informed consent obtained prior to any screening procedures

        Exclusion Criteria:

          -  Patients who have received prior everolimus or ceritinib

          -  Patients with known history of extensive disseminated bilateral interstitial fibrosis
             or interstitial lung disease, including a history of pneumonitis, hypersensitivity
             pneumonitis, interstitial pneumonia, obliterative bronchiolitis, and clinically
             significant radiation pneumonitis (i.e. affecting activities of daily living or
             requiring therapeutic intervention)

          -  Patients currently receiving anticancer therapies or who have received anticancer
             therapies within 4 weeks including chemotherapy, radiation therapy, antibody based
             therapy, etc.

          -  Known intolerance or hypersensitivity to everolimus or other rapamycin analogs (e.g.
             sirolimus, temsirolimus)

          -  Patients with known hypersensitivity to any of the excipients of ceritinib
             (microcrystalline cellulose, mannitol, crospovidone, colloidal silicon dioxide and
             magnesium stearate)

          -  Known impairment of gastrointestinal (GI) function or GI disease that may
             significantly alter the absorption of oral everolimus

          -  Uncontrolled diabetes mellitus as defined by hemoglobin A1c (HbA1c) > 8% despite
             adequate therapy; patients with a known history of impaired fasting glucose or
             diabetes mellitus (DM) may be included, however blood glucose and antidiabetic
             treatment must be monitored closely throughout the trial and adjusted as necessary

          -  Patient has clinically significant, uncontrolled heart disease and/or recent cardiac
             event (within 6 months), such as:

               -  Unstable angina within 6 months prior to screening

               -  Myocardial infarction within 6 months prior to screening

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

               -  Uncontrolled hypertension defined by a systolic blood pressure (SBP) >= 160 mmHg
                  and/or diastolic blood pressure (DBP) >= 100 mmHg, with or without
                  antihypertensive medication - initiation or adjustment of antihypertensive
                  medication(s) is allowed prior to screening

               -  Ventricular arrhythmias; supraventricular and nodal arrhythmias not controlled
                  with medication

               -  Other cardiac arrhythmia not controlled with medication

               -  Corrected QT interval (QTc) > 450 msec using Fridericia correction on the
                  screening electrocardiogram (ECG)

          -  Patients who have any severe and/or uncontrolled medical conditions such as:

               -  Active (acute or chronic) or uncontrolled severe infection, liver disease such as
                  cirrhosis, decompensated liver disease, and chronic hepatitis (i.e. quantifiable
                  hepatitis B virus test [hepatitis B virus (HBV)-deoxyribonucleic acid (DNA)]
                  and/or positive hepatitis B surface antigen [HbsAg], quantifiable hepatitis C
                  virus test [hepatitis C virus (HCV)-ribonucleic acid (RNA)])

               -  Known severely impaired lung function (spirometry and carbon monoxide diffusing
                  capacity [DLCO] 50% or less of normal and oxygen [O2] saturation 88% or less at
                  rest on room air)

               -  Active, bleeding diathesis

          -  Chronic treatment with high dose corticosteroids or other immunosuppressive agents;
             topical, inhaled, and low dose oral corticosteroids are allowed provided stable dosing
             for at least 2 weeks

          -  Receiving medications that meet one of the following criteria and that cannot be
             discontinued at least 1 week prior to the start of treatment with ceritinib and for
             the duration of the study participation:

               -  Medication with a known risk of prolonging the QT interval or inducing Torsades
                  de Pointes

               -  Strong inhibitors or strong inducers of cytochrome P450, family 3, subfamily A,
                  polypeptide 4/cytochrome P450, family 3, subfamily A, polypeptide 5 (CYP3A4/5)

               -  Medications with a low therapeutic index that are primarily metabolized by
                  CYP3A4/5, cytochrome P450, family 2, subfamily C, polypeptide 8 (CYP2C8) and/or
                  cytochrome P450, family 2, subfamily C, polypeptide 9 (CYP2C9)

               -  Therapeutic doses of warfarin sodium (Coumadin) or any other Coumadin-derived
                  anti-coagulant; anticoagulants not derived from warfarin are allowed (e.g.,
                  dabigatran, rivaroxaban, apixaban)

               -  Unstable or increasing doses of corticosteroids

               -  Enzyme-inducing anticonvulsive agents

               -  Herbal supplements

          -  Known history of human immunodeficiency virus (HIV) seropositivity

          -  Patients who have received live attenuated vaccines within 1 week of start of
             everolimus and during the study; patient should also avoid close contact with others
             who have received live attenuated vaccines; examples of live attenuated vaccines
             include intranasal influenza, measles, mumps, rubella, oral polio, Bacillus
             Calmette-Guerin (BCG), yellow fever, varicella and TY21a typhoid vaccines

          -  Patients who have a history of another primary malignancy unless the patient has been
             disease free for >= 3 years

          -  Patients with a history of non-compliance to medical regimens or who are considered
             potentially unreliable or will not be able to complete the entire study

          -  Patients who are currently part of or have participated in any clinical investigation
             with an investigational drug within 1 month prior to dosing (except ALK inhibitors)

          -  Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a
             female after conception and until the termination of gestation, confirmed by a
             positive hCG laboratory test

          -  Women of child-bearing potential (WOCBP), defined as all women physiologically capable
             of becoming pregnant, unless they are using highly effective methods of contraception
             during dosing and for 3 months after the last dose of study treatment; highly
             effective contraception methods include:

               -  Total abstinence (when this is in line with the preferred and usual lifestyle of
                  the subject; periodic abstinence (e.g., calendar, ovulation, symptothermal,
                  post-ovulation methods) and withdrawal are not acceptable methods of
                  contraception

               -  Female sterilization (have had surgical bilateral oophorectomy with or without
                  hysterectomy) or tubal ligation at least six weeks before taking study treatment;
                  in case of oophorectomy alone, only when the reproductive status of the woman has
                  been confirmed by follow up hormone level assessment

               -  Male sterilization (at least 6 months prior to screening) with the appropriate
                  post-vasectomy documentation of the absence of sperm in the ejaculate; for female
                  subjects on the study the vasectomized male partner should be the sole partner
                  for that subject

               -  Combination of any two of the following:

                    -  Use of oral, injected or implanted hormonal methods of contraception or
                       other forms of hormonal contraception that have comparable efficacy (failure
                       rate < 1%), for example hormone vaginal ring or transdermal hormone
                       contraception

                    -  Placement of an intrauterine device (IUD) or intrauterine system (IUS)

                    -  Barrier methods of contraception: condom or occlusive cap (diaphragm or
                       cervical/vault caps) with spermicidal foam/gel/film/cream/vaginal
                       suppository; in case of use of oral contraception, women should have been
                       stable on the same pill for a minimum of 3 months before taking study
                       treatment; 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 have had surgical bilateral oophorectomy (with or
                       without hysterectomy) or tubal ligation at least six weeks prior to
                       screening; 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

          -  Sexually active males unless they use a condom during intercourse while taking drug
             and for 3 months after the last dose of study treatment; male patients for 3 months
             should not father a child in this period; a condom is required to be used also by
             vasectomized men in order to prevent delivery of the drug via seminal fluid; also male
             patients whose sexual partner(s) are WOCBP who are not willing to use adequate
             contraception during the study and for 3 months after the end of enrollment
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Maximum tolerated dose (MTD) of ceritinib and everolimus, defined as the highest dose level in which 6 patients were treated with at most 1 experiencing a dose limiting toxicity
Time Frame:28 days
Safety Issue:
Description:MTD will be assessed.

Secondary Outcome Measures

Measure:Response rate
Time Frame:Up to 28 days after discontinuation of study drugs
Safety Issue:
Description:Evaluated based upon Response Evaluation Criteria in Solid Tumors (RECIST) 1.1.
Measure:Progression-free survival
Time Frame:Time from the start of the study until disease progressive or death, assessed up to 28 days after discontinuation of study drugs
Safety Issue:
Description:Progression free survival will be analyzed.
Measure:Pharmacokinetic parameters of everolimus and ceritinib
Time Frame:Days 1, 15, and 21 (course 1), day 1 (course 2), day 1 (course 3), and at progression
Safety Issue:
Description:Estimated and calculated using a noncompartmental pharmacokinetic model. Plasma concentrations and pharmacokinetic parameters for each drug dose will be summarized using descriptive statistics and the mean plasma concentrations for each drug dose will be plotted versus time.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:M.D. Anderson Cancer Center

Last Updated

February 17, 2020