Clinical Trials /

A Study to Evaluate the Safety and Tolerability of ETC-1922159 in Advanced Solid Tumours

NCT02521844

Description:

This is a Phase 1A/B study consisting of four parts. 1. Part A (completed) is a non-randomised, open-label, sequential evaluation of the safety, pharmacokinetics (PK), maximum tolerated dose (MTD), and recommended dose (RD) of ETC-1922159 in patients with advanced or metastatic, or unresectable solid malignancies, for whom no approved treatment option or standard of care is available. Dose escalation, with the goal of identifying the MTD and RD, is guided by an ordinal continual reassessment method (oCRM) model with a cohort size of one patient. 2. Part A extension (completed) is a non-randomised, non-comparative, open-label evaluation of the safety and tolerability of ETC-1922159 together with the bone protective treatment (denosumab) in patients with advanced or metastatic, or unresectable solid malignancies, for whom no approved treatment option or standard of care is available. 3. Part B dose escalation will be a non-randomised, open-label, sequential evaluation of the MTD, RD, safety, PK, and PD (pharmacodynamics) of ETC 1922159 in combination with pembrolizumab in patients with advanced or metastatic, or unresectable solid malignancies, for whom no approved treatment option or standard of care is available. 4. Part B dose expansion will be a non-randomised, non-comparative, open-label study evaluation of the safety and tolerability of ETC-1922159 as a single agent until disease progression and then in combination with pembrolizumab at the RD identified in the Part B dose escalation segment, in patients with advanced or metastatic, or unresectable solid malignancies that are refractory, intolerant or not suitable for available treatment according to the treating physician. It is anticipated that the study will take approximately 78 months to complete (36 months for Part A and Part A Extension, approximately 6 months for Part B dose escalation and approximately 36 months for Part B dose expansion).

Related Conditions:
  • Colorectal Carcinoma
  • Endometrial Carcinoma
  • Malignant Solid Tumor
  • Ovarian Carcinoma
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: A Study to Evaluate the Safety and Tolerability of ETC-1922159 in Advanced Solid Tumours
  • Official Title: A Phase 1A/B Study to Evaluate the Safety and Tolerability of ETC-1922159 in Advanced Solid Tumours

Clinical Trial IDs

  • ORG STUDY ID: D3-002
  • NCT ID: NCT02521844

Conditions

  • Solid Tumors

Interventions

DrugSynonymsArms
ETC-1922159Dose Escalation
PembrolizumabDose Escalation

Purpose

This is a Phase 1A/B study consisting of four parts. 1. Part A (completed) is a non-randomised, open-label, sequential evaluation of the safety, pharmacokinetics (PK), maximum tolerated dose (MTD), and recommended dose (RD) of ETC-1922159 in patients with advanced or metastatic, or unresectable solid malignancies, for whom no approved treatment option or standard of care is available. Dose escalation, with the goal of identifying the MTD and RD, is guided by an ordinal continual reassessment method (oCRM) model with a cohort size of one patient. 2. Part A extension (completed) is a non-randomised, non-comparative, open-label evaluation of the safety and tolerability of ETC-1922159 together with the bone protective treatment (denosumab) in patients with advanced or metastatic, or unresectable solid malignancies, for whom no approved treatment option or standard of care is available. 3. Part B dose escalation will be a non-randomised, open-label, sequential evaluation of the MTD, RD, safety, PK, and PD (pharmacodynamics) of ETC 1922159 in combination with pembrolizumab in patients with advanced or metastatic, or unresectable solid malignancies, for whom no approved treatment option or standard of care is available. 4. Part B dose expansion will be a non-randomised, non-comparative, open-label study evaluation of the safety and tolerability of ETC-1922159 as a single agent until disease progression and then in combination with pembrolizumab at the RD identified in the Part B dose escalation segment, in patients with advanced or metastatic, or unresectable solid malignancies that are refractory, intolerant or not suitable for available treatment according to the treating physician. It is anticipated that the study will take approximately 78 months to complete (36 months for Part A and Part A Extension, approximately 6 months for Part B dose escalation and approximately 36 months for Part B dose expansion).

Trial Arms

NameTypeDescriptionInterventions
Dose EscalationExperimentalETC-1922159 + pembrolizumab
  • ETC-1922159
  • Pembrolizumab
Dose ExpansionExperimentalETC-1922159 as single agent until disease progression, then in combination with pembrolizumab at the recommended dose (RD) identified in the dose escalation segment
  • ETC-1922159
  • Pembrolizumab

Eligibility Criteria

        Inclusion Criteria (Part B):

          -  18+ yrs (US), 21+ yrs (Singapore)

          -  Ability to give informed consent

          -  Histologically/cytologically confirmed advanced or metastatic tumors, that are
             unresectable solid malignancies, and that are are refractory, intolerant or not
             suitable to available treatment

          -  Objective and radiologically confirmed disease progression at screening

          -  Measurable disease by RECIST v1.1

          -  ECOG (Eastern Cooperative Oncology Group) 0-2

          -  Life expectancy ≥3 months

          -  Organ function:

               -  Absolute neutrophil count ≥1.0×10^9/L

               -  Platelets ≥100×10^9/L (w/o transfusions w/in 21 days)

               -  Hemoglobin ≥9 g/dL

               -  PT (prothrombin time) and PTT (partial thromboplastin time) w/in ≤1.5× ULN

               -  International normalised ration (INR) ≤1.5× ULN

               -  Total bilirubin ≤1.5× ULN

               -  Transaminases (AST and/or alanine aminotransferase) ≤2.5× ULN (<5× ULN with liver
                  metastases)

               -  Creatinine clearance ≥60 mL/min

               -  Total calcium (corrected for serum albumin) within normal limits

               -  Magnesium ≥ lower limit of normal (LLN)

               -  Normal urinalysis

          -  Patients with osteopenia (T-score of -1 to -2.5 at L/R total hip, L/R femoral neck or
             lumbar spine [L1-L4]) eligible

          -  Capable of swallowing study medication or has caregiver responsible for administering
             study drug

          -  Negative serum pregnancy test

          -  Dose Expansion - Group 1 and Group 2a only (patients with MSS [microsatellite
             stable]-colorectal cancer [CRC]): Is refractory, intolerant or not suitable for
             treatment with fluoropyrimidine, oxaliplatin, or irinotecan.

          -  Dose Expansion - Group 1 patients: MSS-CRC with confirmed presence of at least one of
             the four different recurrent gene fusions involving RSPO2 or RSPO3 (Fusions A-D).

          -  Dose Expansion - Group 2a patients: Has MSS-CRC with confirmed absence of all four
             different recurrent gene fusions involving RSPO2 or RSPO3 (Fusions A-D).

          -  Dose Expansion - Groups 2b and 2c only (patients with MSS-ovarian and MSS-endometrial
             cancer): Has advanced or metastatic disease for which further conventional therapy,
             e.g. platinum-based chemotherapy, is not suitable. Has MSS tumour as determined by IHC
             (immunohistochemistry), PCR (polymerase chain reaction) or NGS (next generation
             sequencing).

          -  Dose Expansion: All patients must have sufficient archival tumour tissue available, or
             if no archival tumour tissue or tumour ribonucleic acid (RNA) sample is available, the
             patient must have tumour sites that allow conduction of biopsies.

          -  Dose Expansion: Pre-dose and post-dose tumour biopsies are mandatory unless tumour is
             inaccessible or deemed unsafe for procedure by principal investigator.

        Exclusion Criteria (Part B):

          -  Male patient with sexual partner(s) of childbearing potential unwilling to use
             contraception. Sexually active male patients must use a condom during intercourse
             during the study and for 12 weeks after the end of treatment. Condom must also be used
             by vasectomised males.

          -  Female of childbearing potential, unless birth control is used during study and for 12
             weeks after end of treatment.

          -  Pregnant or nursing (lactating) female.

          -  Dose Escalation: Current or anti-cancer therapy within 4 weeks pre-study or with Grade
             ≤1 side effects not resolved within 4 weeks pre-study.

          -  Dose Expansion: Has received previous treatment with pembrolizumab or other immune
             checkpoint inhibitors.

          -  Is receiving any concomitant anti-cancer therapy.

          -  Has used other investigational products within 4 weeks or 5 half-lives (whichever is
             longer) prior to first dose of study drug.

          -  Has evidence of other malignancy not in remission or history of other malignancy
             within last 3 yrs (exceptions: treated basal or skin squamous cell carcinoma or in
             situ cancer of cervix)

          -  Has central nervous system metastases, unless treated with surgery, whole brain
             radiation or stereotactic radiosurgery, and stable disease ≥8 weeks without steroid
             use for ≥4 weeks prior to first dose of study drug.

          -  Has received prior radiation therapy within 4 weeks, or limited field radiation within
             2 weeks, prior to study drug, or with unresolved Grade ≤1 side effects .

          -  Has history of radiation to spine/pelvis bone or chemoradiation to pelvic organs.

          -  Has had major surgical procedure within 4 weeks of starting study drug. Or patient has
             not fully recovered from all surgery-related complications to Grade ≤1.

          -  Has a history of interstitial lung disease, sarcoidosis, silicosis, idiopathic
             pulmonary fibrosis, or pulmonary hypersensitivity pneumonitis.

          -  Has received bisphosphonate therapy for osteoporosis or symptomatic hypercalcaemia, or
             denosumab for osteoporosis prior to starting study drug.

          -  Has osteoporosis (T-score of ≤ -2.5 at left or right total hip, left or right femoral
             neck, or lumbar spine [L1-L4] by DEXA scan).

          -  Has a history of symptomatic vertebral fragility fractures or fragility fracture of
             hip, pelvis, wrist, or other location (fragility fracture - any fracture without
             trauma or as a result of a fall from ≤standing height).

          -  Has moderate (25%-40% decrease vertebral height) or severe (>40% decrease vertebral
             height) morphometric vertebral fractures.

          -  Has B-CTX serum level >600 pg/mL in the morning after at least 10 hours of fasting at
             Screening.

          -  Has thyrotropin level less than lower limit of normal (LLN).

          -  Has 25-hydroxy vitamin D levels less than 50 mmol/L (20 ng/mL).

          -  Has bone metastases.

          -  Has a history of long QT or prolonged QTc (>460 ms).

          -  Is receiving, or has received thiazolidinedione peroxisome proliferator-activated
             receptor gamma agonist (e.g. Actos® [pioglitazone] and Avandia® [rosiglitazone]) w/in
             4 wks prior to starting study drug.

          -  Has metabolic bone disease such as hyperparathyroidism, Paget's disease or
             osteomalacia.

          -  Has a known clinically significant bleeding disorder or coagulopathy.

          -  Is receiving or has received within 4 weeks prior to starting study drug, heparin,
             warfarin or similar anti-coagulants (except for patients on low molecular weight
             heparin for treatment or prophylaxis).

          -  Has severe or unstable medical conditions such as heart failure, ischemic heart
             disease, uncontrolled hypertension, uncontrolled diabetes mellitus, psychiatric
             condition, ongoing cardiac arrhythmia requiring medication (Grade ≥2, by National
             Cancer Institute [NCI] CTCAE v. 4.03).

          -  Has a known history of human immunodeficiency virus (HIV) or active bacterial, viral
             or fungal infections.

          -  Has a history of gastric bypass surgery.

          -  Has received prior treatment with an inhibitor of the Wnt-B-catenin pathway.

          -  Is unwilling or unable to comply with the protocol.

          -  Cannot start treatment with the bone protective treatment with denosumab and/or
             zoledronic acid.

          -  Dose Expansion: Patient is unable to provide tumour tissue (from archival tissue or a
             fresh biopsy or tumour RNA).

          -  Has received prophylactic administration of hematopoietic colony stimulating factors
             within 4 weeks prior to starting study drug.

          -  Is receiving active treatment with an oral or IV glucocorticoid for ≥4 weeks at a
             daily dose equivalent to ≥10 mg of oral prednisone within the 12 weeks prior to
             starting the study drug.

          -  Has recent or current active infectious disease requiring systemic antibiotics or
             antifungal or antiviral treatment within 2 weeks prior to the start of the study drug.
             Subjects receiving prophylactic antibiotics (e.g. for prevention of urinary tract
             infection or chronic obstructive pulmonary disease) are eligible.

          -  Has a serious non-healing wound.

          -  Has a history of vasculitis.

          -  Has an active autoimmune disease that has required systemic treatment in the past 2
             years. Replacement therapy is not considered a form of systemic treatment.

          -  Has received a live vaccine within 28 days prior to the start of the study drug.

        Other protocol-defined inclusion and exclusion criteria may apply.
      
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 ETC-1922159 when administered with pembrolizumab (Part B Dose Escalation)
Time Frame:For 2 cycles (42 days)
Safety Issue:
Description:

Secondary Outcome Measures

Measure:Number of participants with adverse events (AEs) (Part B Dose Escalation)
Time Frame:From date of enrolment until end of treatment
Safety Issue:
Description:
Measure:Number of participants with adverse bone density imaging assessments via DEXA scan (Part B Dose Escalation)
Time Frame:From date of enrolment until end of treatment
Safety Issue:
Description:
Measure:Number of participants with abnormal 12-lead electrocardiogram (ECG) readings (Part B Dose Escalation)
Time Frame:From date of enrolment until end of treatment
Safety Issue:
Description:
Measure:Change in Eastern Cooperative Oncology Group performance status (Part B Dose Escalation)
Time Frame:From date of enrolment until end of treatment
Safety Issue:
Description:
Measure:Number of participants with abnormal clinical laboratory test results (Part B Dose Escalation)
Time Frame:From date of enrolment until end of treatment
Safety Issue:
Description:
Measure:Number of participants with abnormal vital sign measurements (Part B Dose Escalation)
Time Frame:From date of enrolment until end of treatment
Safety Issue:
Description:
Measure:Tolerability measured by monitoring of fatigue and gastrointestinal-related side effects and when applicable, immune-related side effects in patients (Part B Dose Escalation)
Time Frame:From date of enrolment until end of treatment
Safety Issue:
Description:
Measure:Clinical activity measured by RECIST (Response Evaluation Criteria in Solid Tumours) version 1.1 and iRECIST (Response Evaluation Criteria in Solid Tumours modified for immune-based therapeutics) (Part B Dose Expansion)
Time Frame:From date of enrolment until end of treatment
Safety Issue:
Description:
Measure:ETC-1922159 Maximum plasma concentration (Cmax) (Part B)
Time Frame:From date of enrolment until end of treatment
Safety Issue:
Description:
Measure:ETC-1922159 Area under the curve (AUC) (Part B)
Time Frame:From date of enrolment until end of treatment
Safety Issue:
Description:
Measure:Retrospective evaluation of plasma/serum concentration of pembrolizumab (Part B)
Time Frame:From date of enrolment to Cycle 2 for Dose Escalation and Cycle 1 of combination therapy for Dose Expansion
Safety Issue:
Description:
Measure:Retrospective evaluation of plasma/serum concentration of bone protective agents, if administered (Part B)
Time Frame:Before and after the first administration only
Safety Issue:
Description:

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:EDDC (Experimental Drug Development Centre), A*STAR Research Entities

Trial Keywords

  • solid tumors
  • responsive to Wnt signalling regulation
  • RSPO fusions
  • Porcupine
  • PD-1
  • MSS
  • CRC
  • endometrial cancer
  • ovarian cancer

Last Updated

September 1, 2020