Clinical Trials /

Ph1b Study of Oraxol in Comb. w. Ramucirumab in Patients w. Gastric, Gastro-esophageal, or Esophageal Cancers

NCT02970539

Description:

This is a nonrandomized, open-label, single group assignment, safety, tolerability and pharmacokinetic (PK) study to determine the MTD and optimal dosing regimen of Oraxol in combination with ramucirumab.

Related Conditions:
  • Adenocarcinoma of the Gastroesophageal Junction
  • Esophageal Adenocarcinoma
  • Gastric Adenocarcinoma
Recruiting Status:

Active, not recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Ph1b Study of Oraxol in Comb. w. Ramucirumab in Patients w. Gastric, Gastro-esophageal, or Esophageal Cancers
  • Official Title: A Phase 1b Study of Oraxol in Combination With Ramucirumab in Patients With Gastric, Gastro-esophageal, or Esophageal Cancers

Clinical Trial IDs

  • ORG STUDY ID: KX-ORAX-005
  • NCT ID: NCT02970539

Conditions

  • Gastric Cancer
  • Esophageal Cancer
  • Gastro-esophageal Cancer

Interventions

DrugSynonymsArms
Oraxoloral HM30181AK-US tablet and paclitaxel capsuleOraxol +Ramucirumab
RamucirumabLY3009806Oraxol +Ramucirumab

Purpose

This is a nonrandomized, open-label, single group assignment, safety, tolerability and pharmacokinetic (PK) study to determine the MTD and optimal dosing regimen of Oraxol in combination with ramucirumab.

Detailed Description

      This is a sequential-group, dose escalation trial to determine the maximum tolerated dose of
      oral Oraxol in combination with intravenous ramucirumab. After a screening period of up to 28
      days subjects will be enrolled into the treatment phase of the study. Each cycle of therapy
      will last 4 weeks. Subjects may continue in the study until they experience disease
      progression or unacceptable toxicity. Three to six subjects will be enrolled at each dose
      level. Once the tolerability of a dose level has been determined, an additional 3-6 subjects
      may be enrolled at a higher dose level, to determine the maximum tolerated dose. Safety will
      be monitored through recording of adverse events, serious adverse events, monitoring of
      laboratory tests including hematology, blood chemistry, urinalyses, physical examinations and
      electrocardiograms. Subjects will undergo radiographic assessments for tumor response at
      specified time points. Blood samples will also be obtained in the first cycle of therapy at
      multiple time points for determination of the amount of paclitaxel and metabolites and
      HM30181 in the circulation. After the treatment period, there will be a follow-up period
      during which the subject or family may be contacted every three months for follow-up.
    

Trial Arms

NameTypeDescriptionInterventions
Oraxol +RamucirumabExperimentalOraxol (oral HM30181 + oral paclitaxel) HM30181 methanesulfonate monohydrate - supplied as 15-mg HM30181AK-US tablets Paclitaxel - supplied as 30-mg capsules Ramucirumab - supplied as a solution at a concentration of 10 mg/mL
  • Oraxol
  • Ramucirumab

Eligibility Criteria

        Inclusion Criteria:

          -  Subjects must meet all of the following criteria to be included in this study:

             1. Signed written informed consent 2. ≥18 years of age 3. Histologically or
             cytologically confirmed diagnosis of advanced stage gastric, gastro-esophageal (Part 1
             or Part 2), or esophageal adenocarcinoma (Part 1 only) with disease progression on or
             after prior fluoropyrimidine- or platinum-containing chemotherapy 4. Have documented
             testing for HER2-neu overexpression, and for those with tumors overexpressing
             HER2-neu, have documented progression on Trastuzumab-containing therapy 5. Measurable
             disease on computed tomography (CT) scan of thorax, abdomen, and pelvis, per RECIST
             v1.1 criteria 6. Able to swallow oral medication as an intact dosage form 7. Adequate
             hematologic status as demonstrated by not requiring transfusion support or
             granulocyte-colony stimulating factor (G-CSF) to maintain:

               -  ANC ≥1500 cells/mm3

               -  Platelet count ≥100 x 109/L

               -  Hemoglobin ≥10 g/dL; subjects with thalassemia having a hemoglobin <10 g/dL may
                  be enrolled, per Investigator discretion 8. Adequate liver function as
                  demonstrated by:

               -  Total bilirubin of ≤1.5 mg/dL

               -  Alanine aminotransferase (ALT) ≤3 x upper limit of normal (ULN) or ≤5 x ULN if
                  liver metastasis is present

               -  Alkaline phosphatase ≤3 x ULN or ≤5 x ULN if bone or liver metastasis is present

               -  Gamma-glutamyl transferase (GGT) <10 x ULN 9. Adequate renal function as
                  demonstrated by:

               -  Serum creatinine ≤1.5 x ULN or creatinine clearance calculation ≥60 mL/min as
                  calculated by the Cockcroft and Gault formula

               -  Urinary protein ≤1+. If urinary protein is ≥2+, a 24-hour urine collection for
                  protein must demonstrate <1000 mg of protein in 24 hours to allow participation
                  in this protocol.

                  10. Normal prothrombin time (PT) or international normalized ratio (INR) and
                  normal activated partial thromboplastin time (aPTT) unless subject is on
                  anticoagulation therapy 11. Eastern Cooperative Oncology Group (ECOG) performance
                  status of 0 to 1 12. Life expectancy of at least 3 months 13. Women must be
                  postmenopausal (>12 months without menses) or surgically sterile (ie, by
                  hysterectomy and/or bilateral oophorectomy) or must be using effective
                  contraception (ie, oral contraceptives, intrauterine device, double barrier
                  method of condom and spermicide) and agree to continue use of contraception for
                  30 days after their last dose of study drug.

                  14. Sexually active male subjects must use a barrier method of contraception
                  during the study and agree to continue the use of male contraception for at least
                  30 days after the last dose of study drug.

        Exclusion Criteria

        Subjects who meet any of the following criteria will be excluded from this study:

          1. Unresolved toxicity from previous anticancer treatments, including investigational
             products (subjects must have recovered all unacceptable toxicity to ≤ Grade 1 Common
             Terminology Criteria for Adverse Events [CTCAE] toxicity). This does not extend to
             symptoms or findings that are attributable to the underlying disease.

          2. Received investigational products within 14 days or 5 half-lives of the first study
             dosing day, whichever is longer; subjects receiving biologic agents (eg, monoclonal
             antibodies) require a 30-day washout period.

          3. Are currently receiving other medications or radiation intended for the treatment of
             their malignancy

          4. Central nervous system metastases, including leptomeningeal involvement

          5. Women of childbearing potential who are pregnant or breastfeeding

          6. Currently taking a concomitant medication, other than a premedication, that is:

               -  A strong P-glycoprotein (P-gp) inhibitor or inducer. Subjects who are taking such
                  medications but who are otherwise eligible may be enrolled if they discontinue
                  the medication ≥1 week before dosing

               -  An oral medication with a narrow therapeutic index known to be a P-gp substrate
                  within 24 hours prior to start of dosing in the study

               -  Medications known to be strong inhibitors (gemfibrozil) or inducers (rifampin) of
                  cytochrome P450 (CYP) 2C8 or medications known to be strong CYP3A4 inhibitors
                  (eg, ketoconazole) or inducers (eg, rifampin or St. John's Wort). Subjects who
                  are currently taking such medications but who are otherwise eligible may be
                  enrolled if they discontinue the medication 1 week before dosing and remain off
                  that medication during treatment with Oraxol.

          7. Use of warfarin. Participants receiving warfarin who are otherwise eligible and who
             may be appropriately managed with low molecular weight heparin, in the opinion of the
             Investigator, may be enrolled in the study provided they are switched to low molecular
             weight heparin at least 7 days prior to receiving study treatment.

          8. Require chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs), chronic
             antiplatelet therapy, dipyridamole, clopidogrel, or similar agents. Aspirin up to 325
             mg per day is allowed.

          9. Unable to receive iv contrast for required CT scans

         10. Poorly-controlled hypertension (>160 mm Hg systolic or >100 mm Hg diastolic for >4
             weeks) despite standard medical management. Subjects may be rescreened after
             adjustment of their antihypertensive medication.

         11. Serious or nonhealing wound, ulcer, or bone fracture within 28 days prior to first
             dose of protocol therapy

         12. Prior history of GI perforation/fistula (within 6 months of first dose of protocol
             therapy) or risk factors for perforation

         13. Grade 3 or 4 GI bleeding within 3 months prior to first dose of protocol therapy

         14. Arterial thromboembolic event including, but not limited to, myocardial infarction,
             transient ischemic attack, cerebrovascular accident, or unstable angina within 6
             months prior to first dose of protocol therapy

         15. Deep vein thrombosis (DVT) or pulmonary embolus or any other significant
             thromboembolic event during the 3 months prior to first dose of protocol therapy

         16. Child-Pugh Class B or C cirrhosis of the liver or cirrhosis (any degree) and a history
             of hepatic encephalopathy or a history of ascites resulting from cirrhosis requiring
             diuretics or paracentesis

         17. Uncontrolled intercurrent illness including, but not limited to, ongoing or active
             infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
             arrhythmia, poorly controlled diabetes or diabetes with established vascular
             complications, chronic pulmonary disease requiring oxygen, known bleeding disorders,
             or any concomitant illness or social situation that would limit compliance with study
             requirements

         18. Medical condition that, in the opinion of the investigator, may interfere with oral
             drug absorption

         19. Major surgery within 28 days prior to first dose of protocol therapy, or minor
             surgery/subcutaneous venous access device placement within 7 days prior to the first
             dose of protocol therapy, or elective or major surgery planned to be performed during
             the course of the clinical trial

         20. History of hypersensitivity to paclitaxel, not attributed to a hypersensitivity type
             reaction to Cremophor®, or history of hypersensitivity type reaction to polysorbate 80
             or other components of the formulation of Oraxol

         21. History of developing any condition during prior treatment with ramucirumab for which
             ramucirumab must be permanently discontinued according to the ramucirumab
             Investigator's Brochure
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Maximum tolerated dose (MTD)
Time Frame:The first 4 weeks
Safety Issue:
Description:The primary endpoint of determining the MTD will be based on DLT

Secondary Outcome Measures

Measure:To determine the safety and tolerability of Oraxol in combination with ramucirumab
Time Frame:through study completion
Safety Issue:
Description:Safety assessments will consist of determining and recording all AEs (including for both increasing and decreasing severity) and SAEs
Measure:The recommended Phase 2 dose of Oraxol in combination with ramucirumab
Time Frame:One month
Safety Issue:
Description:Evaluation of the 3-day MTD for Oraxol in combination with ramucirumab, including safety, tolerability, and pharmacokinetics, will be used to determine the recommended Phase 2 dose
Measure:To characterize the area under the blood concentration curve (AUCt) of Oraxol in combination with ramucirumab
Time Frame:Day 1 and 3: Predose, 8 timepoints up to 8 hours postdose; Day 2: Predose; Day 8 and 15: Predose, and between 1 and 3 hours postdose
Safety Issue:
Description:Derived by noncompartmental analysis using the plasma concentration-time data of Oraxol (paclitaxel and its major metabolites, 3'-p-hydroxy paclitaxel and 6α-hydroxy paclitaxel, and HM30181 methanesulfonate monohydrate and its M1 metabolite)
Measure:To characterize the area under the plasma concentration-time curve from 0 to 8 hours (AUC0-8h) of Oraxol in combination with ramucirumab
Time Frame:Day 1 and 3: Predose, 8 timepoints up to 8 hours postdose; Day 2: Predose; Day 8 and 15: Predose, and between 1 and 3 hours postdose
Safety Issue:
Description:Derived by noncompartmental analysis using the plasma concentration-time data of Oraxol (paclitaxel and its major metabolites, 3'-p-hydroxy paclitaxel and 6α-hydroxy paclitaxel, and HM30181 methanesulfonate monohydrate and its M1 metabolite)
Measure:To characterize the maximum observed plasma concentration (Cmax) of Oraxol in combination with ramucirumab
Time Frame:Day 1 and 3: Predose, 8 timepoints up to 8 hours postdose; Day 2: Predose; Day 8 and 15: Predose, and between 1 and 3 hours postdose
Safety Issue:
Description:Derived by noncompartmental analysis using the plasma concentration-time data of Oraxol (paclitaxel and its major metabolites, 3'-p-hydroxy paclitaxel and 6α-hydroxy paclitaxel, and HM30181 methanesulfonate monohydrate and its M1 metabolite)
Measure:To characterize the minimum observed plasma concentration (Cmin) of Oraxol in combination with ramucirumab
Time Frame:Day 1 and 3: Predose, 8 timepoints up to 8 hours postdose; Day 2: Predose; Day 8 and 15: Predose, and between 1 and 3 hours postdose
Safety Issue:
Description:Derived by noncompartmental analysis using the plasma concentration-time data of Oraxol (paclitaxel and its major metabolites, 3'-p-hydroxy paclitaxel and 6α-hydroxy paclitaxel, and HM30181 methanesulfonate monohydrate and its M1 metabolite)
Measure:To characterize the plasma half-life (t1/2) of Oraxol in combination with ramucirumab
Time Frame:Day 1 and 3: Predose, 8 timepoints up to 8 hours postdose; Day 2: Predose; Day 8 and 15: Predose, and between 1 and 3 hours postdose
Safety Issue:
Description:Derived by noncompartmental analysis using the plasma concentration-time data of Oraxol (paclitaxel and its major metabolites, 3'-p-hydroxy paclitaxel and 6α-hydroxy paclitaxel, and HM30181 methanesulfonate monohydrate and its M1 metabolite)
Measure:To characterize the accumulation factor (R) of Oraxol in combination with ramucirumab
Time Frame:Day 1 and 3: Predose, 8 timepoints up to 8 hours postdose; Day 2: Predose; Day 8 and 15: Predose, and between 1 and 3 hours postdose
Safety Issue:
Description:Derived by noncompartmental analysis using the plasma concentration-time data of Oraxol (paclitaxel and its major metabolites, 3'-p-hydroxy paclitaxel and 6α-hydroxy paclitaxel, and HM30181 methanesulfonate monohydrate and its M1 metabolite)
Measure:To characterize the apparent volume of distribution (Vd/F) of Oraxol in combination with ramucirumab
Time Frame:Day 1 and 3: Predose, 8 timepoints up to 8 hours postdose; Day 2: Predose; Day 8 and 15: Predose, and between 1 and 3 hours postdose
Safety Issue:
Description:Derived by noncompartmental analysis using the plasma concentration-time data of Oraxol (paclitaxel and its major metabolites, 3'-p-hydroxy paclitaxel and 6α-hydroxy paclitaxel, and HM30181 methanesulfonate monohydrate and its M1 metabolite)
Measure:To characterize the apparent total clearance (CL/F) of Oraxol in combination with ramucirumab
Time Frame:Day 1 and 3: Predose, 8 timepoints up to 8 hours postdose; Day 2: Predose; Day 8 and 15: Predose, and between 1 and 3 hours postdose
Safety Issue:
Description:Derived by noncompartmental analysis using the plasma concentration-time data of Oraxol (paclitaxel and its major metabolites, 3'-p-hydroxy paclitaxel and 6α-hydroxy paclitaxel, and HM30181 methanesulfonate monohydrate and its M1 metabolite)
Measure:Preliminary activity of Oraxol plus ramucirumab as determined by response rate
Time Frame:Subjects will be evaluated for tumor response per RECIST v1.1 criteria after every 8 weeks (ie, at Weeks 9, 17, 25, etc).
Safety Issue:
Description:Tumor response will be evaluated according to RECIST v1.1 criteria
Measure:Preliminary activity of Oraxol plus ramucirumab as determined by progression-free survival
Time Frame:Subjects will be evaluated for tumor response per RECIST v1.1 criteria after every 8 weeks (ie, at Weeks 9, 17, 25, etc).
Safety Issue:
Description:Tumor response will be evaluated according to RECIST v1.1 criteria
Measure:Preliminary activity of Oraxol plus ramucirumab as determined by overall survival
Time Frame:Investigator,telephone, or family member contact or public records access will be performed every 3 months for the purpose of assessing overall survival.
Safety Issue:
Description:There will be a Follow-up Period during which survival data will be collected

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Active, not recruiting
Lead Sponsor:Athenex, Inc.

Last Updated

August 17, 2021