Clinical Trials /

A Study of E6201 for the Treatment of Advanced Hematologic Malignancies With FLT3 and/or Ras Mutations

NCT02418000

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.

Related Conditions:
  • Acute Myeloid Leukemia
  • Chronic Myelomonocytic Leukemia
  • Myelodysplastic Syndromes
Recruiting Status:

Terminated

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

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

  • AML
  • MDS
  • CMML

Interventions

DrugSynonymsArms
E6201Dual inhibitor of FLT3 and MEK1E6201 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

NameTypeDescriptionInterventions
E6201 240 mg/m^2 IV weeklyExperimentalE6201 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
E6201 320 mg/m^2 IV weeklyExperimentalE6201 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
E6201 160 mg/m^2 IV twice weeklyExperimentalE6201 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
E6201 240 mg/m^2 IV twice weeklyExperimentalE6201 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
E6201 320 mg/m^2 IV twice weeklyExperimentalE6201 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)
  • E6201

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