Description:
This is a Phase 1/2a dose-escalation study of E6201, a dual mitogen-activated protein
kinase/extracellular-signal regulated kinase 1 (MEK1) and FMS-like tyrosine kinase 3 (FLT3)
inhibitor, in subjects with advanced hematologic malignancies with documented FLT3 and/or rat
sarcoma (Ras) mutations. The Phase1 portion of the study will be a safety run-in (up to 30
subjects) to establish a recommended Phase 2 dose (RP2D). The Ph. 2a portion of the study
will evaluate three specific patients groups: Cohort 1 will enroll patients with relapsed or
refractory AML and confirmed FLT3 mutation (with or without a Ras mutation) without prior
exposure to a FLT3 inhibitor; Cohort 2 will enroll patients with relapsed or refractory AML
and confirmed FLT3 mutation (with or without a Ras mutation) with prior exposure to a FLT3
inhibitor; Cohort 3 will enroll patients with relapsed or refractory AML with a confirmed Ras
mutation and no FLT3 mutation.
Title
- Brief Title: A Study of E6201 for the Treatment of Advanced Hematologic Malignancies With FLT3 and/or Ras Mutations
- Official Title: A Phase 1/2a Study of E6201 for the Treatment of Advanced Hematologic Malignancies With FLT3 and/or Ras Mutations, Including Acute Myeloid Leukemia (AML), Myelodysplastic Syndrome (MDS) or Chronic Myelomonocytic Leukemia (CMML)
Clinical Trial IDs
- ORG STUDY ID:
BSC-101-01
- NCT ID:
NCT02418000
Conditions
Interventions
Drug | Synonyms | Arms |
---|
E6201 | Dual inhibitor of FLT3 and MEK1 | E6201 160 mg/m^2 IV twice weekly |
Purpose
This is a Phase 1/2a dose-escalation study of E6201, a dual mitogen-activated protein
kinase/extracellular-signal regulated kinase 1 (MEK1) and FMS-like tyrosine kinase 3 (FLT3)
inhibitor, in subjects with advanced hematologic malignancies with documented FLT3 and/or rat
sarcoma (Ras) mutations. The Phase1 portion of the study will be a safety run-in (up to 30
subjects) to establish a recommended Phase 2 dose (RP2D). The Ph. 2a portion of the study
will evaluate three specific patients groups: Cohort 1 will enroll patients with relapsed or
refractory AML and confirmed FLT3 mutation (with or without a Ras mutation) without prior
exposure to a FLT3 inhibitor; Cohort 2 will enroll patients with relapsed or refractory AML
and confirmed FLT3 mutation (with or without a Ras mutation) with prior exposure to a FLT3
inhibitor; Cohort 3 will enroll patients with relapsed or refractory AML with a confirmed Ras
mutation and no FLT3 mutation.
Detailed Description
Phase 1 (Safety Run-In): Following Screening, a total of up to 30 subjects in up to 5 dose
cohorts to establish the RP2D. The safety run-in phase will be a standard 3+3 cohort design.
Phase 2a (Expansion): Once the Phase 1 Safety Run-In portion of the study is complete and an
RP2D is established, additional subjects will be enrolled into the Phase 2 Expansion portion
in three cohorts. Cohort 1 will enroll up to 26 patients with relapsed or refractory AML and
confirmed FLT3 mutation (with or without a Ras mutation) without prior exposure to a FLT3
inhibitor. Cohort 2 will enroll up to 26 patients with relapsed or refractory AML and
confirmed FLT3 mutation (with or without a Ras mutation) with prior exposure to a FLT3
inhibitor. Cohort 3 will enroll up to 10 patients with relapsed or refractory AML with a
confirmed Ras mutation and no FLT3 mutation. Cohort 1 and 2 of the Expansion Phase will
incorporate a Simon 2-stage optimal design. Subjects with AML enrolled in the Phase 1 portion
of the study at the RP2D will count towards the Phase 2a accrual for the appropriate cohort.
Subjects will receive E6201 weekly or bi-weekly on a 28-day schedule, with the schedule and
dose level established in the Safety Run-In portion of the study. Disease assessments,
including analysis of blood and bone marrow samples, will be performed at the end of Cycles 1
and 3 and every 2 cycles thereafter. Disease assessments may be made at other time points at
the discretion of the Investigator.
Subjects who demonstrate clinical benefit (objective response or stable disease) will be
allowed to continue therapy with E6201 until progression of disease, observation of
unacceptable adverse events, intercurrent illness or changes in the patient's condition that
prevents further study participation.
During the study, ECGs will be performed, blood will be collected for hematology, serum
chemistry, pharmacokinetics and pharmacodynamics assessments, and bone marrow will be
collected for the assessment of disease response and mutational status.
Trial Arms
Name | Type | Description | Interventions |
---|
E6201 240 mg/m^2 IV weekly | Experimental | E6201 240 mg/m^2 administered IV over 2 hours once weekly, on Days 1, 8, 15, and 22, repeated every 28 days (= 1 cycle) | |
E6201 320 mg/m^2 IV weekly | Experimental | E6201 320 mg/m^2 administered IV over 2 hours once weekly, on Days 1, 8, 15, and 22, repeated every 28 days (= 1 cycle) | |
E6201 160 mg/m^2 IV twice weekly | Experimental | E6201 160 mg/m^2 administered IV over 2 hours twice weekly, on Days 1, 4, 8, 11, 15, 18, 22 and 25, repeated every 28 days (= 1 cycle) | |
E6201 240 mg/m^2 IV twice weekly | Experimental | E6201 240 mg/m^2 administered IV over 2 hours twice weekly, on Days 1, 4, 8, 11, 15, 18, 22 and 25, repeated every 28 days (= 1 cycle) | |
E6201 320 mg/m^2 IV twice weekly | Experimental | E6201 320 mg/m^2 administered IV over 2 hours twice weekly, on Days 1, 4, 8, 11, 15, 18, 22, and 25, repeated every 28 days (= 1 cycle) | |
Eligibility Criteria
Inclusion Criteria:
- Males and females ≥ 18 years of age
- Phase 1: Confirmed relapsed or refractory AML with a documented FLT3 and/or Ras
mutation, or ≥ 60 years with newly diagnosed FLT3+ and/or Ras+ AML and not eligible
for standard induction chemotherapy or FLT3+ and/or Ras+ higher-risk MDS/CMML (defined
as ≥ 10% marrow blasts or ≥ 5% peripheral blood blasts or Revised International
Prognostic Scoring System [IPSS-R] score ≥ 3.5) and relapsed or refractory to prior
therapy
- Phase 2: Confirmed relapsed or refractory AML with a documented FLT3 and/or Ras
mutation, or age ≥ 60 years with newly diagnosed FLT3+ and/or Ras+ AML and not
eligible for standard induction chemotherapy
- At least 3 weeks beyond the last cancer treatment for the disease under study, major
surgery and recovered from all acute toxicities (≤ Grade 1) by first dose of study
drug (C1D1). Hydroxyurea used to control peripheral blast counts is permitted during
the first 2 cycles.
- Adequate performance status Eastern Cooperative Oncology Group (ECOG) ≤ 2
- Adequate renal and hepatic function:
- creatinine ≤ 1.5 mg/dL OR calculated creatinine clearance ≥ 45 mL/minute
- total bilirubin ≤ 2 times the upper limit of normal (ULN) unless due to Gilbert's
disease or thought to be due to underlying AML
- ALT and AST ≤ 5 times ULN
- Negative serum pregnancy test within 14 days prior to the first dose of study therapy
for women of child-bearing potential (WCBP). Sexually active WCBP and male subjects
must agree to use adequate methods to avoid pregnancy throughout the study and for 28
days after completion of study treatment.
- Ability to provide written informed consent
Exclusion Criteria:
- History of clinically significant cardiac impairment, congestive heart failure (CHF)
New York Heart Association (NYHA) Class III or IV, unstable angina, or myocardial
infarction during the previous 6 months, or serious cardiac arrhythmia
- QT interval corrected for rate (QTc) ≥ 450 msec for males and ≥ 460 msec for females
on the ECG obtained at Screening using Fridericia method for QTc calculation (average
of 3 readings)
- Concomitant medication(s) that may cause QTc prolongation or induce Torsades de
Pointes with the exception of anti-microbials used as standard of care to prevent or
treat infections and other such drugs that are considered by the investigator to be
essential for the care of the patient. However, if such medications are deemed to be
necessary during the study, more extensive ECG monitoring will be added during the
period of concomitant drug administration.
- Presence of active central nervous system (CNS) leukemia. Subjects adequately treated
for CNS leukemia documented by 2 consecutive cerebrospinal fluid samples negative for
leukemia cells are eligible. Subjects with no history of CNS leukemia will not be
required to undergo cerebrospinal fluid sampling for eligibility.
- Known positive for human immunodeficiency virus (HIV), hepatitis B virus surface
antigen (HBsAg), or hepatitis C virus HCV)
- Active, uncontrolled infection
- Known hypersensitivity to any study drug component
- History of another malignancy; Exception: Patients disease-free for 2 years or treated
in situ carcinoma
- Any other medical intervention or other condition which, in the opinion of the
Principal Investigator, could compromise adherence to study requirements or confound
the interpretation of study results
- Pregnancy or lactation
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 E6201 |
Time Frame: | Up to 6 weeks for each dose cohort |
Safety Issue: | |
Description: | Phase 1 (Safety Run-In) was conducted in 5 dose cohorts in up to 30 subjects in a standard 3+3 dose-escalation design to establish an MTD and recommended Phase 2 dose (RP2D). Safety assessed through the monitoring of adverse events (AEs), serious adverse events (SAEs), clinical laboratory parameters (hematology and serum chemistry), vital sign measurements, electrocardiograms (ECGs) and physical examinations. |
Secondary Outcome Measures
Measure: | Overall Response Rate |
Time Frame: | At the end of C1 and every 2 cycles thereafter through 6 months following last dose of study drug |
Safety Issue: | |
Description: | For acute myeloid leukemia (AML): Revised Recommendations of the International Working Group (IWG) Response Criteria for AML: CR: Free of leukemia-related symptoms, absolute neutrophil count (ANC) > 1.0 x 10^9/L, platelet count ≥ 100 x 10^9/L, normal bone marrow with < 5% blasts and no Auer rods. CRi: As per CR but w/ residual thrombocytopenia (platelet count <100 x 10^9/L) or residual neutropenia (ANC <1.0 x 10^9/L). PR: ≥50% decrease bone marrow blasts to 5 - 25% abnormal cells, or CR w/ ≤ 5% blasts if Auer rods present.
For myelodysplastic syndrome (MDS) and chronic myelomonocytic leukemia (CMML): Modified IWG Response Criteria for MDS: CR: Free of leukemia-related symptoms, ANC ≥1.0 x 10^9/L, platelet count ≥100 x 10^9/L, bone marrow ≤5% myeloblasts, normal maturation of all cell lines, hemoglobin ≥ 11g/dL, no blasts in the peripheral blood. PR: All CR criteria w/ ≥50% decrease in bone marrow blasts over pre-treatment, but still > 5%. |
Measure: | Duration of Response |
Time Frame: | At the end of C1 and every 2 cycles thereafter through 6 months following last dose of study drug |
Safety Issue: | |
Description: | Length of time from the first evidence of objective response to the first evidence of progression |
Measure: | Progression-Free Survival |
Time Frame: | From Cycle 1 Day 1 (C1D1) until death or study closure, up to 26 months |
Safety Issue: | |
Description: | Length of time from the date of first administration of study drug to the first evidence of disease progression or death, whichever is earlier |
Measure: | Overall Survival |
Time Frame: | From C1D1 until death or study closure, up to 26 months |
Safety Issue: | |
Description: | Length of time from the date of first administration of study drug to the date of death from any cause |
Measure: | Pharmacokinetic Profile of E6201 in Plasma: Cmax |
Time Frame: | Assessed at Cycle 1 Days 1 and 15, Cycle 2 Day 1, pre-dose, 5 minutes following the end of the 2-hour infusion, 2, 4, 8 and 24 hours post-infusion. Summary PK parameters for Cycle 1 Day 1 reported. |
Safety Issue: | |
Description: | Cmax: Maximum measured plasma concentration over the collection period |
Measure: | Pharmacokinetics of E6201 in Plasma: Tmax |
Time Frame: | Assessed at Cycle 1 Days 1 and 15, Cycle 2 Day 1, pre-dose, 5 minutes following the end of the 2-hour infusion, 2, 4, 8 and 24 hours post-infusion. Summary PK parameters for Cycle 1 Day 1 reported. |
Safety Issue: | |
Description: | Tmax: Time to maximum measured plasma concentration |
Measure: | Pharmacokinetic Profile of E6201 in Plasma: AUCT |
Time Frame: | Assessed at Cycle 1 Days 1 and 15, Cycle 2 Day 1, pre-dose, 5 minutes following the end of the 2-hour infusion, 2, 4, 8 and 24 hours post-infusion. Summary PK parameters for Cycle 1 Day 1 reported. |
Safety Issue: | |
Description: | Area under the plasma concentration versus time curve (AUC) to the last measurable concentration over the sampling time-interval. |
Measure: | Pharmacokinetic Profile of E6201 in Plasma: AUCI |
Time Frame: | Assessed at Cycle 1 Days 1 and 15, Cycle 2 Day 1, pre-dose, 5 minutes following the end of the 2-hour infusion, 2, 4, 8 and 24 hours post-infusion. Summary PK parameters for Cycle 1 Day 1 reported. |
Safety Issue: | |
Description: | AUCI: The area under the concentration versus time curve from time 0 to infinity |
Measure: | Pharmacokinetic Profile of E6201 in Plasma: T1/2 |
Time Frame: | Assessed at Cycle 1 Days 1 and 15, Cycle 2 Day 1, pre-dose, 5 minutes following the end of the 2-hour infusion, 2, 4, 8 and 24 hours post-infusion. Summary PK parameters for Cycle 1 Day 1 reported. |
Safety Issue: | |
Description: | T1/2: The apparent first-order elimination half-life |
Measure: | Pharmacokinetic Profile of E6201 in Plasma: CLobs |
Time Frame: | Assessed at Cycle 1 Days 1 and 15, Cycle 2 Day 1, pre-dose, 5 minutes following the end of the 2-hour infusion, 2, 4, 8 and 24 hours post-infusion. Summary PK parameters for Cycle 1 Day 1 reported. |
Safety Issue: | |
Description: | Clearance observed (CLobs): Total body clearance for extravascular administration |
Measure: | Pharmacokinetic Profile of E6201 in Plasma: VDobs |
Time Frame: | Assessed at Cycle 1 Days 1 and 15, Cycle 2 Day 1, pre-dose, 5 minutes following the end of the 2-hour infusion, 2, 4, 8 and 24 hours post-infusion. Summary PK parameters for Cycle 1 Day 1 reported. |
Safety Issue: | |
Description: | Measurement of apparent volume of distribution observed (VDobs) |
Measure: | Number of Participants With Suppression of pERK at 4 Hours Post-dose |
Time Frame: | Cycle 1 Day 1, 4 hours post-dose. |
Safety Issue: | |
Description: | phospho-ERK (pERK) in blood assessed by Western blot at 4 hours post-dose |
Measure: | Number of Participants With Suppression of pERK at 24 Hours Post-dose |
Time Frame: | Cycle 1 Day 1, 24 hours post-dose. |
Safety Issue: | |
Description: | Measurement of phospho-ERK (pERK) in blood assessed by Western blot at 24 hours post-dose |
Measure: | Number of Participants With Suppression of pFLT3 at 4 Hours Post-dose |
Time Frame: | Cycle 1 Day 1, 4 hours post-dose. |
Safety Issue: | |
Description: | phospho-FLT3 (pFLT3) in blood assessed by Western blot at 4 hours post-dose |
Measure: | Number of Participants With Suppression of pFLT3 at 24 Hours Post-dose |
Time Frame: | Cycle 1 Day 1, 24 hours post-dose. |
Safety Issue: | |
Description: | phospho-FLT3 (pFLT3) in blood assessed by Western blot at 24 hours post-dose |
Measure: | Number of Participants With Suppression of pAKT at 4 Hours Post-dose |
Time Frame: | Cycle 1 Day 1, 4 hours post-dose. |
Safety Issue: | |
Description: | phospho-AKT (pAKT) in blood assessed by Western blot at 4 hours post-dose |
Measure: | Number of Participants With Suppression of pAKT at 24 Hours Post-dose |
Time Frame: | Cycle 1 Day 1, 24 hours post-dose. |
Safety Issue: | |
Description: | phospho-AKT (pAKT) in blood assessed by Western blot at 24 hours post-dose |
Measure: | Number of Participants With Suppression of pERK by PIA at 4 Hours Post-dose |
Time Frame: | Cycle 1 Day 1, 4 hours post-dose. |
Safety Issue: | |
Description: | Blood assay: Plasma inhibitory assay (PIA) measuring pERK in blood at 4 hours post-dose |
Measure: | Number of Participants With Suppression of in pERK by PIA 24 Hours Post-dose |
Time Frame: | Cycle 1 Day 1, 24 hours post-dose. |
Safety Issue: | |
Description: | Blood assay: Plasma inhibitory assay (PIA) measuring pERK in blood at 24 hours post-dose |
Measure: | Number of Participants With Suppression of pFLT3 by PIA at 4 Hours Post-dose |
Time Frame: | Cycle 1 Day 1, 4 hours post-dose. |
Safety Issue: | |
Description: | Blood assay: Plasma inhibitory assay (PIA) measuring pFLT3 in blood at 4 hours post-dose |
Measure: | Number of Participants With Suppression of pFLT3 by PIA at 24 Hours Post-dose |
Time Frame: | Cycle 1 Day 1, 24 hours post-dose. |
Safety Issue: | |
Description: | Blood assay: Plasma inhibitory assay (PIA) measuring pFLT3 in blood at 24 hours post-dose |
Details
Phase: | Phase 1/Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Terminated |
Lead Sponsor: | Spirita Oncology, LLC |
Last Updated
March 20, 2019