Clinical Trials /

Preoperative Ceritinib (LDK378) in Glioblastoma Multiforme and CNS Metastasis

NCT02605746

Description:

This is two parallel studies to examine pharmacokinetic (PK), pharmacodynamic (PD), and pharmacogenetic (PG) endpoints following short-interval therapy (10-14) daily doses without dose reduction and interruption) with the ALK (anaplastic lymphoma kinase) small-molecule inhibitor, ceritinib. The Phase 0 study will investigate: 1. first recurrence GBM patients and 2. patients with CNS metastases from solid tumors such as, but not limited to, NSCLC (non-small cell lung cancer) and melanoma. The CNS (central nervous system) metastases Phase 0 is designed to identify PK effects (in addition to PD, and PG effects on ALK-positive NSCLC metastases), while the GBM Phase 0 is designed to identify PK, PD, and PG effects in all patients.

Related Conditions:
  • Central Nervous System Neoplasm
  • Glioblastoma
Recruiting Status:

Completed

Phase:

Early Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Preoperative Ceritinib (LDK378) in Glioblastoma Multiforme and CNS Metastasis
  • Official Title: A Phase 0/II Study of Ceritinib (LDK378) in Preoperative Glioblastoma Multiforme (GBM) and CNS Metastasis Patients Scheduled for Resection to Evaluate Central Nervous System (CNS) Penetration

Clinical Trial IDs

  • ORG STUDY ID: PHX15BN068
  • NCT ID: NCT02605746

Conditions

  • Glioblastoma
  • Brain Metastases

Interventions

DrugSynonymsArms
ceritinib 750mg2-4 hours

Purpose

This is two parallel studies to examine pharmacokinetic (PK), pharmacodynamic (PD), and pharmacogenetic (PG) endpoints following short-interval therapy (10-14) daily doses without dose reduction and interruption) with the ALK (anaplastic lymphoma kinase) small-molecule inhibitor, ceritinib. The Phase 0 study will investigate: 1. first recurrence GBM patients and 2. patients with CNS metastases from solid tumors such as, but not limited to, NSCLC (non-small cell lung cancer) and melanoma. The CNS (central nervous system) metastases Phase 0 is designed to identify PK effects (in addition to PD, and PG effects on ALK-positive NSCLC metastases), while the GBM Phase 0 is designed to identify PK, PD, and PG effects in all patients.

Detailed Description

      This study is being done to learn about a new drug, Ceritinib (LKD378). The results of the
      study may reveal how the drug works for cancer that spreads to the brain (metastases) and for
      a type of brain cancer called glioblastoma (GBM). Subjects are persons scheduled to have
      surgery to remove the tumor.This study would test how much of the new drug is present in the
      tumor, blood, and cerebrospinal fluid (CSF) after taking the drug orally for 10-14 days
      before surgery. It is only given to patients who are already scheduled to have surgery to
      remove a tumor that has returned. If the drug seems to be working for a subject's tumor,
      subject will have the option to continue to receive it as part of a continuation study
      looking at the drug effect on preventing the tumor from recurring. Small samples of blood,
      tumor tissue, and CSF will be taken. These samples will be sent to and analyzed at the
      Barbara Ann Karmanos Cancer Institute (KCI) and to the Translational Genomics Research
      Institute (TGen). Subject involvement will be for 10-14 days before surgery and for 30 days
      following surgery. Patients with ALK+ solid tumors will be provided the option of continuing
      therapy until tumor progression. ALK positivity will be assessed by approved FISH test
      (Abbott Molecular Inc) using Vysis break apart probes (defined as 15% or more positive tumor
      cells), the Ventana IHC (immunohistochemistry) test, and/or NGS (next generation sequencing).
    

Trial Arms

NameTypeDescriptionInterventions
2-4 hoursExperimentalAll patients will be orally-administered 10-14 doses of ceritinib 750mg with the final dose occurring at one of three intervals before brain tumor resection. This arm has the last ceritinib dose 2-4 hours prior to craniotomy for tumor resection.
  • ceritinib 750mg
4-8 hoursExperimentalAll patients will be orally-administered 10-14 doses of ceritinib 750mg with the final dose occurring at one of three intervals before brain tumor resection. This arm has the last ceritinib dose 4-8 hours prior to craniotomy for tumor resection.
  • ceritinib 750mg
22-26 hoursExperimentalAll patients will be orally-administered 10-14 doses of ceritinib 750mg with the final dose occurring at one of three intervals before brain tumor resection. This arm has the last ceritinib dose 22-26 hours prior to craniotomy for tumor resection.
  • ceritinib 750mg

Eligibility Criteria

        Inclusion Criteria:

          -  One prior resection of GBM or MRI evidence of solid tumor CNS metastasis

          -  All GBM and NSLC metastases must be ALK+

          -  Eastern Cooperative Oncology Group performance status ≤2

          -  Archival tumor tissue block available for research use

          -  Ability to understand written informed consent

          -  Recovery from toxicities related to prior anticancer therapies to ≤ grade 2 (CTCAE v
             4.03). Exception: patients with any grade alopecia

          -  The following lab criteria are met:

               -  Absolute neutrophil count ≥ 1.5 x 10(9th power)/L

               -  Hemoglobin ≥ 8 g/dL

               -  Platelets ≥ 75 x 10(9th power)/L

               -  Serum total bilirubin ≤ 1.5 x upper limit of normal(ULN), except for patients
                  with Gilbert's syndrome who may be included if total bilirubin ≤ 3.0 x ULN and
                  direct bilirubin ≤ 1.5 x ULN

               -  Aspartate transaminase (AST) < 3.0 x ULN, except for patients with liver
                  metastasis, who are only included if AST < 5 x ULN; alanine transaminase (ALT) <
                  3.0 x ULN, except for patients with liver metastasis, who are only included if
                  ALT < 5 x ULN

               -  Creatinine clearance ≥ 30 mL/min

          -  Patient has following lab values or has lab values corrected with supplements to be
             within normal limits at screening:

               -  Potassium ≥ LLN

               -  Magnesium ≥ LLN

               -  Phosphorus ≥ LLN

               -  Total calcium (corrected for serum albumin) ≥ LLN

        Exclusion Criteria:

          -  Co-morbid condition(s) that prevent safe surgical treatment

          -  Active infection or fever > 38.5°C

          -  Patients with known hypersensitivity to any excipients of ceritinib

          -  Prior therapy with 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 (affecting activities of daily living or requiring
             therapeutic intervention)

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

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

               -  uncontrolled hypertension defined by a Systolic Blood Pressure ≥ 160 mm Hg and/or
                  Diastolic Blood Pressure ≥ 100 mm Hg, 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 QTc > 450 msec using Fridericia correction on the screening ECG

          -  Impaired GI function or GI disease that may alter absorption of ceritinib or inability
             to swallow up to five ceritinib capsules daily

          -  Ongoing GI adverse events > grade 2 (e.g. nausea, vomiting, or diarrhea) at the start
             of the study

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

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

               -  Strong inhibitors or strong inducers of CYP3A4/5

               -  Medications with a low therapeutic index that are primarily metabolized by
                  CYP3A4/5, CYP2C8 and/or CYP2C9

               -  Therapeutic doses of warfarin sodium (Coumadin) or any other coumadin-derived
                  anti-coagulant. Anticoagulants not derived from warfarin are allowed

          -  Pregnant or nursing (lactating) women.

          -  Women of child-bearing potential, unless they are using highly effective methods of
             contraception during dosing and for 3 months after the last dose of study treatment.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Plasma Concentration
Time Frame:at pre-dose on day 10-14(Day 0), 0.5, 1, 2, 4, 6, 8, and 24 hours following single dose of CERITINIB
Safety Issue:
Description:Plasma concentration of Ceritinib after 10-14 oral doses of 750 mg. Will be summarized using descriptive statistics.

Secondary Outcome Measures

Measure:Tumor Tissue
Time Frame:at baseline(archival) and up to 26 hours post dosing
Safety Issue:
Description:Tumor tissue quantification of total and phosphorylated forms of ALK, JAK/STAT5B, and Caspase-3. Will be summarized using descriptive statistics.
Measure:Tumor Cells in M-Phase
Time Frame:at baseline and up to 26 hours post dose CERITINIB
Safety Issue:
Description:Number of tumor cells in M-phase of cell cycle (PH3). Will be summarized using descriptive statistics.
Measure:Double Strand DNA
Time Frame:at baseline and up to 26 hours post dose CERITINIB
Safety Issue:
Description:Presence of double-strand DNA damage (γH2AX). Will be summarized using descriptive statistics.
Measure:Tissue Concentration
Time Frame:2-4, 4-8, and 22-26 hours post dosing relative to the final Day 10 dose, as compared to the immediate pre-operative MRI scan
Safety Issue:
Description:Tissue concentration of CERITINIB compared to contrast enhancing GBM vs. surrounding nonenhancing FLAIR-hyperintense GBM. Will be summarized using descriptive statistics.

Details

Phase:Early Phase 1
Primary Purpose:Interventional
Overall Status:Completed
Lead Sponsor:St. Joseph's Hospital and Medical Center, Phoenix

Last Updated

December 11, 2020