Clinical Trials /

CB-839 + Capecitabine in Solid Tumors and Fluoropyrimidine Resistant PIK3CA Mutant Colorectal Cancer

NCT02861300

Description:

This study has two portions. The main goal of the Phase I portion of this research study is to see what doses of CB-839 and capecitabine can safely be given to patients without having too many side effects. Other purposes of this research study will be to determine what side effects are seen with this combination of medicines. The Phase II portion of the study will test how many patients show shrinkage in their tumor with this combination of medicines and what changes occur inside the cancer cells and blood cells after treatment.

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

Recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: CB-839 + Capecitabine in Solid Tumors and Fluoropyrimidine Resistant PIK3CA Mutant Colorectal Cancer
  • Official Title: Phase I/II Study of CB-839 and Capecitabine in Patients With Advanced Solid Tumors and Fluoropyrimidine Resistant PIK3CA Mutant Colorectal Cancer

Clinical Trial IDs

  • ORG STUDY ID: CASE1216
  • NCT ID: NCT02861300

Conditions

  • Colorectal Cancer
  • Colon Cancer
  • Rectal Cancer
  • Solid Tumor

Interventions

DrugSynonymsArms
CB-839CB-839 + capecitabine
CapecitabineXelodaCB-839 + capecitabine

Purpose

This study has two portions. The main goal of the Phase I portion of this research study is to see what doses of CB-839 and capecitabine can safely be given to patients without having too many side effects. Other purposes of this research study will be to determine what side effects are seen with this combination of medicines. The Phase II portion of the study will test how many patients show shrinkage in their tumor with this combination of medicines and what changes occur inside the cancer cells and blood cells after treatment.

Detailed Description

      Phase I Primary Objective:

      To determine the safety, tolerability and recommended phase II dose (RP2D) of combination
      CB-839 and capecitabine chemotherapy in patients with advanced solid tumors for whom there
      are no remaining treatment options or for whom single agent capecitabine is an acceptable
      therapy.

      Phase II Primary Objective:

      To determine the disease control rate of combination CB-839 and capecitabine chemotherapy in
      patients with metastatic PIK3CA mutant colorectal cancers who are refractory to
      fluoropyrimidine based therapy.

      Phase I Secondary Objectives:

      To determine the dose-limiting toxicities and maximum tolerated dose of combination therapy
      with CB-839 and capecitabine in patients with advanced solid tumors for whom there are no
      remaining treatment options or for whom single agent capecitabine is an acceptable therapy.

      To determine the disease control rate as assessed by RECIST criteria of combination therapy
      with CB-839 and capecitabine in patients with advanced solid tumors for whom there are no
      remaining treatment options or for whom single agent capecitabine is an acceptable therapy.

      Phase II Secondary Objectives:

      To determine the progression free survival following treatment with CB-839 and capecitabine
      chemotherapy in patients with metastatic PIK3CA mutant colorectal cancer and are refractory
      to fluoropyrimidine therapy.

      To determine the overall survival following treatment with CB-839 and capecitabine
      chemotherapy in patients who have metastatic PIK3CA mutant colorectal cancer and are
      refractory to fluoropyrimidine therapy.
    

Trial Arms

NameTypeDescriptionInterventions
CB-839 + capecitabineExperimentalPatients will receive CB-839 orally twice daily for 21 days (continuous administration) and capecitabine orally twice daily for 14/21 days. In the phase I portion of the study, patients will receive escalating doses of CB-839 and capecitabine and will have day 15 blood samples drawn and archived for as needed assessment of CB-839 pharmacokinetics. In the phase II portion of the study, patients will receiving 800mg CB-839 and 1000mg/m^2 capecitabine as were determined to be safe doses during the phase I portion of the study. They will also undergo pre-treatment and post-treatment blood samples and tissue biopsies for evaluation of pharmacodynamic biomarkers.
  • CB-839
  • Capecitabine

Eligibility Criteria

        Inclusion Criteria:

          -  Phase I

               -  Patients must have an advanced solid tumors for whom there are no remaining
                  treatment options or colorectal patients who have progressed on front-line
                  fluoropyrimidine containing therapy. Patients with colorectal cancer must have
                  progressed on at least one line of fluoropyrimidine containing therapy. Receipt
                  of either oxaliplatin or irinotecan in combination with a fluoropyrimidine is
                  required in the front line setting for all colorectal cancer patients unless
                  either of these agents are otherwise contraindicated in the opinion of the
                  treating physician. Prior regorafenib or TAS-102 therapy is not required.

               -  Patients must have an Eastern Cooperative Oncology Group (ECOG) performance
                  status of 0-1

               -  Patients must have normal organ and marrow function as defined below:

                    -  Hemoglobin ≥ 9.0 g/dl

                    -  Leukocytes ≥ 3,000/mcL

                    -  Absolute neutrophil count ≥ 1,500/mcL

                    -  Platelet count ≥ 100,000/mcL

                    -  Serum creatinine ≤ 1.5 X institutional upper limit of normal

                    -  Total bilirubin ≤ 1.5mg/dL

                    -  Aspartate Aminotransferase (AST) serum glutamic oxaloacetic transaminase
                       (SGOT) ≤ 2.5 X institutional upper limit of normal

                    -  Alanine Aminotransferase (ALT) serum glutamic pyruvic transaminase (SGPT) ≤
                       2.5 x institutional upper limit of normal

               -  Patients must be able to swallow pills.

               -  Patients must have the ability to understand and the willingness to sign a
                  written informed consent document.

               -  Female patients of childbearing potential must have a negative serum or urine
                  pregnancy test within 3 days prior to the first dose of study drug and agree to
                  use dual methods of contraception during the study and for a minimum of 3 months
                  following the last dose of study drug. Post-menopausal females (>45 years old and
                  without menses for >1 year) and surgically sterilized females are exempt from
                  these requirements. Male patients must use an effective barrier method of
                  contraception during the study and for a minimum of 3 months following the last
                  dose of study drug if sexually active with a female of childbearing potential.

          -  Phase II

               -  Patients must have histologically or cytologically confirmed,
                  phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA)
                  mutant metastatic colorectal cancer. PIK3CA status must be confirmed by tumor
                  sequencing in a CLIA certified lab.

               -  Patients must have measurable disease according to Response Evaluation Criteria
                  In Solid Tumors (RECIST) 1.1 criteria that is amenable to biopsy and be willing
                  to undergo pre- and post-treatment tumor biopsies. Lesions to be biopsied do not
                  have to be those used for measurement.

               -  Patients must have received and progressed on fluoropyrimidine or
                  fluoropyrimidine based therapy. Receipt of either oxaliplatin or irinotecan in
                  combination with a fluoropyrimidine is required in the front line setting unless
                  either of these agents are otherwise contraindicated in the opinion of the
                  treating physician in which case a fluoropyrimidine only may be used. Prior
                  regorafenib or TAS-102 therapy is not required.

               -  Patients must have an Eastern Cooperative Oncology Group (ECOG) performance
                  status of 0-1.

               -  Patients must have normal organ and marrow function as defined below:

                    -  Hemoglobin ≥ 9.0 g/dl

                    -  Leukocytes ≥ 3,000/mcL

                    -  Absolute neutrophil count ≥ 1,500/mcL

                    -  Platelet count ≥ 100,000/mcL

                    -  Serum creatinine within normal institutional limits

                    -  Total bilirubin ≤ 1.5 mg/dL

                    -  AST (SGOT) ≤ 2.5 X institutional upper limit of normal

                    -  ALT (SGPT) ≤ 2.5 x institutional upper limit of normal

               -  Patients must be able to swallow pills.

               -  Patients must have the ability to understand and the willingness to sign a
                  written informed consent document.

               -  Female patients of childbearing potential must have a negative serum or urine
                  pregnancy test within 3 days prior to the first dose of study drug and agree to
                  use dual methods of contraception during the study and for a minimum of 3 months
                  following the last dose of study drug. Post-menopausal females (>45 years old and
                  without menses for >1 year) and surgically sterilized females are exempt from
                  these requirements. Male patients must use an effective barrier method of
                  contraception during the study and for a minimum of 3 months following the last
                  dose of study drug if sexually active with a female of childbearing potential.

        Exclusion Criteria:

          -  Both Phase I and Phase II

               -  Patients with ongoing toxicities > grade 1 according to National Cancer Institute
                  (NCI) Common Terminology Criteria For Adverse Events (CTCAE) Version 4.0
                  (excluding alopecia) due to prior anti-cancer therapy.

               -  Patients receiving any other investigational agents or whom have received recent
                  treatment for colorectal cancer (radiation within the previous two weeks,
                  chemotherapy or investigational therapy within the previous four weeks).

               -  Patients with untreated brain metastases/central nervous system disease will be
                  excluded due to their poor prognosis and because they often develop progressive
                  neurologic dysfunction that would confound the evaluation of neurologic and other
                  adverse events.

               -  Patients with a history of allergic reactions attributed to or intolerance to
                  compounds of similar chemical or biologic composition to either CB-839 or
                  capecitabine. If capecitabine has been received previously, must have tolerated
                  at least an equivalent dose to the dose to be administered at their assigned dose
                  level.

               -  Patients who are unable to swallow pills or who have undergone surgery that
                  prohibits the absorption of pills in the stomach.

               -  Patients with uncontrolled intercurrent illness including, but not limited to
                  ongoing or active infection, symptomatic congestive heart failure, unstable
                  angina pectoris or myocardial infarction within prior 6 months, cardiac
                  arrhythmia, or psychiatric illness/social situations that would limit compliance
                  with study requirements.

               -  Patients who are pregnant or breastfeeding will be excluded from the study.

               -  Patients known to be HIV positive who are not receiving anti-retroviral therapy
                  will be excluded due to the marrow suppressive therapy involved in administration
                  of the study treatment.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:19 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:PHASE 1: Recommended dose for phase II study
Time Frame:At least 21 days of treatment
Safety Issue:
Description:The Phase I study has been designed to define the recommended phase II dose of CB-839 and capecitabine. A traditional 3+3 dose escalation design will be adopted. Nine to twenty-four patients are expected to be enrolled, depending on the number of dose escalations and assuming that a total of 6 patients will be treated at the final recommended phase II dose level. Patients who complete the first 21 day treatment cycle of CB-839 and capecitabine chemotherapy will be included in the analysis.

Secondary Outcome Measures

Measure:PHASE 1: proportion of patient who respond to treatment
Time Frame:At least 21 days of treatment
Safety Issue:
Description:Disease control rate will be determined using RECIST criteria. RECIST response categories: Progressive disease (PD): >=20% increase in sum of longest diameter (LD) of target lesion(s), taking as reference smallest sum LD recorded since treatment started. Complete response (CR): disappearance of all target lesions. Partial response (PR): >=30% decrease in sum of LD of target lesion(s), taking as reference baseline sum LD. Stable disease (SD): neither sufficient shrinkage to qualify as PR nor sufficient increase to qualify as PD.

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Case Comprehensive Cancer Center

Trial Keywords

  • CB-839
  • PIK3CA
  • capecitabine

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