Description:
This phase I trial studies the side effects and best dose of neratinib in combination with
everolimus, palbociclib, or trametinib in participants with solid tumors with EGFR
mutation/amplification, HER2 mutation/amplification, HER3/4 mutation, or KRAS mutation that
do not respond to treatment (refractory) and have spread to other parts of the body (advanced
or metastatic). Neratinib, palbociclib, and trametinib may stop the growth of tumor cells by
blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as
everolimus, work in different ways to stop the growth of tumor cells, either by killing the
cells, by stopping them from dividing, or by stopping them from spreading. Giving neratinib
with everolimus, palbociclib, or trametinib may work better than neratinib alone in treating
participants with solid tumors.
Title
- Brief Title: Neratinib and Everolimus, Palbociclib, or Trametinib in Treating Participants With Refractory and Advanced or Metastatic Solid Tumors With EGFR Mutation/Amplification, HER2 Mutation/Amplification, or HER3/4 Mutation or KRAS Mutation
- Official Title: Phase I Study of the Pan-ERBB Inhibitor Neratinib Given in Combination With Everolimus, Palbociclib, or Trametinib in Advanced Cancer Subjects With EGFR Mutation/Amplification, HER2 Mutation/Amplification, or HER3/4 Mutation or KRAS Mutation
Clinical Trial IDs
- ORG STUDY ID:
2016-0430
- SECONDARY ID:
NCI-2018-01218
- SECONDARY ID:
2016-0430
- NCT ID:
NCT03065387
Conditions
- Advanced Malignant Solid Neoplasm
- EGFR Gene Amplification
- EGFR Gene Mutation
- ERBB2 Gene Amplification
- ERBB2 Gene Mutation
- ERBB3 Gene Mutation
- ERBB4 Gene Mutation
- KRAS Gene Mutation
- Metastatic Malignant Solid Neoplasm
- Refractory Malignant Solid Neoplasm
Interventions
Drug | Synonyms | Arms |
---|
Everolimus | 42-O-(2-Hydroxy)ethyl Rapamycin, Afinitor, Certican, RAD 001, RAD001, Votubia, Zortress | Arm I (neratinib, everolimus) |
Neratinib | (2E)-N-(4-((3-chloro-4-((pyridin-2-yl)methoxy)phenyl)amino)-3-cyano-7-ethoxyquinolin-6-yl)-4-(dimethylamino)but-2-enamide, HKI 272, HKI-272, PB 272, PB-272 | Arm I (neratinib, everolimus) |
Palbociclib | 6-Acetyl-8-cyclopentyl-5-methyl-2-((5-(piperazin-1-yl)pyridin-2-yl)amino)-8h-pyrido(2,3-d)pyrimidin-7-one, Ibrance, PD 0332991, PD 332991, PD 991, PD-0332991 | Arm II (neratinib, palbociclib) |
Trametinib | GSK1120212, JTP-74057, MEK Inhibitor GSK1120212, Mekinist | Arm III (neratinib, trametinib) |
Purpose
This phase I trial studies the side effects and best dose of neratinib in combination with
everolimus, palbociclib, or trametinib in participants with solid tumors with EGFR
mutation/amplification, HER2 mutation/amplification, HER3/4 mutation, or KRAS mutation that
do not respond to treatment (refractory) and have spread to other parts of the body (advanced
or metastatic). Neratinib, palbociclib, and trametinib may stop the growth of tumor cells by
blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as
everolimus, work in different ways to stop the growth of tumor cells, either by killing the
cells, by stopping them from dividing, or by stopping them from spreading. Giving neratinib
with everolimus, palbociclib, or trametinib may work better than neratinib alone in treating
participants with solid tumors.
Detailed Description
PRIMARY OBJECTIVES:
I. To evaluate the safety and tolerability of neratinib when combined with one of the
following agents:
Ia. Arm 1: Everolimus (mTOR inhibitor) Ib. Arm 2: Palbociclib (CDK 4/6 inhibitor) Ic. Arm 3:
Trametinib (MEK inhibitor). II. To determine the maximum tolerated dose (MTD) and
dose-limiting toxicities (DLTs) of neratinib combination therapy.
SECONDARY OBJECTIVES:
I. To determine preliminary anti-tumor efficacy of neratinib combination therapy.
II. To determine pharmacodynamic markers in tissue, blood and plasma that may predict
outcome.
III. To explore the potential of drug-drug interactions by evaluating the pharmacokinetic
profile of each agent when administered in these combinations: neratinib+everolimus,
neratinib+palbocclib, and neratinib+trametinib and blood-based biomarkers.
EXPLORATORY OBJECTIVES:
I. To determine baseline molecular markers (deoxyribonucleic acid [DNA], ribonucleic acid
[RNA] and protein) that may predict clinical benefit.
II. To determine concordance of human epidermal growth factor receptor mutation (EGFR, HER2,
HER3, and HER4) or EGFR, HER2 amplification in archival tissue and pre-treatment biopsies.
Impact of these correlatives on response will be explored.
III. To determine concordance of human epidermal growth factor receptor mutation (EGFR, HER2,
HER3, and HER4) or EGFR, HER2 amplification in tumor and cell-free DNA (cfDNA). Impact of
these correlatives on response will be explored.
IV. To utilize cfDNA from plasma specimens collected during the course of treatment to
explore mechanisms of primary and acquired resistance to neratinib combination therapy.
OUTLINE: This is a dose-escalation study. Participants are assigned to 1 of 3 arms.
ARM I: Participants receive neratinib orally (PO) daily and everolimus PO daily. Cycles
repeat every 28 days in the absence of disease progression or unacceptable toxicity.
ARM II: Participants receive neratinib PO daily and palbociclib PO daily for 3 weeks followed
by 1 week off. Cycles repeat every 28 days in the absence of disease progression or
unacceptable toxicity.
ARM III: Participants receive neratinib PO daily and trametinib PO daily as directed. Cycles
repeat every 28 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, participants are followed up at 30 days.
Trial Arms
Name | Type | Description | Interventions |
---|
Arm I (neratinib, everolimus) | Experimental | Participants receive neratinib PO daily and everolimus PO daily. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. | |
Arm II (neratinib, palbociclib) | Experimental | Participants receive Neratinib PO daily for 28 days and Palbociclib PO daily for 21 days. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. | |
Arm III (neratinib, trametinib) | Experimental | Participants receive neratinib PO daily and trametinib PO daily as directed. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. | |
Eligibility Criteria
Inclusion Criteria:
- Subjects with advanced or metastatic solid tumors that are refractory to standard
therapies known to provide clinical benefit. Subjects with hematologic malignancy
including lymphoma/myeloma will not be enrolled on this study.
- Subjects must have one of the following: a. somatic mutations in human epidermal
growth factor receptor (EGFR, HER2, HER3, and HER4); b. EGFR gene amplification
(patients with 3+ results on immunohistochemistry testing for EGFR may be allowed to
enroll if gene amplification results are unavailable); c. HER2 gene amplification
(patients with 3+ results on immunohistochemistry testing for HER-2 may be allowed to
enroll if gene amplification results are unavailable); d. somatic mutation in KRAS
(patients will be enrolled only on neratinib and trametinib combination arm).
- Subjects must have measurable disease by Response Evaluation Criteria in Solid Tumors
(RECIST) version (v) 1.1.
- Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-1.
- Absolute neutrophil count >= 1500/mL.
- Platelets >= 100,000/mL.
- Hemoglobin >= 9 g/dL.
- Creatinine =< 1.5 X upper limit of normal (ULN).
- Total bilirubin =< 1.5 X ULN.
- Aspartate aminotransferase (AST/serum glutamic oxaloacetic transaminase [SGOT]) and/or
alanine aminotransferase (ALT/serum glutamate pyruvate transaminase [SGPT]) =< 2.5 X
ULN (=< 5 X ULN in subjects with liver metastases).
- Subjects must be >= 4 weeks beyond treatment with any chemotherapy or other
investigational therapy to include hormonal, biological, or targeted agents; or at
least 5 half-lives from hormonal, biological, or targeted agents, whichever is shorter
at the time of treatment initiation.
- Women of child-bearing potential MUST have a negative serum or urine human chorionic
gonadotropin (HCG) test unless prior hysterectomy or menopause (defined as 12
consecutive months of amenorrhea). Subjects should not become pregnant or breastfeed
while on this study. Sexually active subjects must agree to use contraception for the
duration of study participation and for 4 months after the last dose of neratinib and
everolimus, palbociclib or trametinib.
- Ability to understand and willingness to sign informed consent form prior to
initiation of the study and any study procedures.
- Only for subjects enrolled in Arm 1 - Neratinib and everolimus: fasting lipid profile:
cholesterol less than or equal to 350 mg/dL and triglycerides less than or equal to
400 mg/dL.
- Only for subjects enrolled in Arm 1 - Neratinib and everolimus: patients who are
taking medications with moderate or potent inhibitors or inducers of CYP450 3A4 should
be off for 5 half-lives prior to starting everolimus.
- Only for subjects enrolled in Arm 2 - Neratinib and palbociclib: any prior neuropathy
should be back to baseline or grade 1.
- Only for subjects enrolled in Arm 2 - Neratinib and palbociclib: patients who are
taking medications with moderate or potent inhibitors or inducers of CYP450 3A4 should
be off for 5 half-lives prior to starting palbociclib.
- Only for subjects enrolled in Arm 3 - Neratinib and trametinib: all skin rash
(dermatitis acneiform, erythema, xeroderma, eczema) should be at grade 1 when starting
trametinib treatment.
- Only for subjects enrolled in Arm 3 - Neratinib and trametinib: history of retinal
disorder, dry eye syndrome, or blurry vision need to be evaluated by ophthalmology
prior to starting treatment.
Exclusion Criteria:
- Subjects who are pregnant or breastfeeding.
- Known hepatitis B, hepatitis C or human immunodeficiency virus (HIV) infection.
- Inability or unwillingness to swallow pills.
- Active infection requiring intravenous (IV) antibiotics or other uncontrolled
intercurrent illness requiring hospitalization.
- Clinically significant gastrointestinal (GI) abnormalities that may alter absorption
such as malabsorption syndrome or major resection of the stomach or bowels. For
example, subjects should have no more than 50% of the large intestine removed and no
sign of malabsorption (e.g. gastrectomy, ileal bypass, chronic diarrhea, Crohn's
disease, malabsorption, gastroparesis).
- Inability to comply with the study and follow-up procedures.
- History of cerebrovascular accident (CVA), myocardial infarction or unstable angina
within the previous 6 months before starting therapy.
- Prolongation of QT/ corrected QT (QTc) interval (QTc interval > 450 ms for males or >
470 ms for females) using the Fridericia method of QTc analysis.
- Has known primary brain tumor, active central nervous system (CNS) metastases and/or
carcinomatous meningitis. Subjects with previously treated brain metastases may
participate provided they are clinically stable with no neurological symptoms, and are
not using steroids for at least 7 days prior to trial treatment. This exception does
not include carcinomatous meningitis which is excluded regardless or clinical
stability.
- Uncontrolled concurrent disease or illness including but not limited to: symptomatic
congestive heart failure (New York Heart Association [NYHA] class III or IV) per the
NYHA classification, unstable angina pectoris, clinically significant cardiac
arrhythmia; unstable or untreated cardiac conditions or ejection fraction of < 50% as
determined by echocardiogram (ECHO) or multiple gated acquisition scan (MUGA);
diabetes mellitus (i.e. fasting blood glucose > 220 despite acceptable chronic
diabetes therapy); psychiatric illness that would limit compliance with study
requirements, as determined by the investigator.
- Participating in any other clinical trials using an investigational product.
- Only for subjects enrolled in Arm 1 - Neratinib and everolimus: history of
hypersensitivity to everolimus.
- Only for subjects enrolled in Arm 1 - Neratinib and everolimus: subjects requiring
therapy with immunosuppressive agents such as anti-tumor necrosis factor alpha (TNFa)
agents (etanercept, adalimumab), azathioprine, methotrexate, cyclosporine, etc. for
active autoimmune disorder.
- Only for subjects enrolled in Arm 1 - Neratinib and everolimus: Major surgery =< 28
days prior to treatment with everolimus.
- Only for subjects enrolled in Arm 3 - Neratinib and trametinib: albumin less than 3
Gm/dL.
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 neratinib when given in combination with everolimus, palbociclib, or trametinib |
Time Frame: | Up to 28 days |
Safety Issue: | |
Description: | Defined by dose-limiting toxicity (DLT). The MTD will be defined as the highest dose at which no more than 1 of 6 evaluable subjects has had a DLT. |
Secondary Outcome Measures
Measure: | Incidence of adverse events of neratinib when given in combination with everolimus, palbociclib, or trametinib |
Time Frame: | Up to 30 days post last dose |
Safety Issue: | |
Description: | National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0 will be used to quantify the intensity of adverse events occurring during treatment in this study. |
Measure: | Objective response |
Time Frame: | Up to 5 years |
Safety Issue: | |
Description: | Per Response Evaluation Criteria in Solid Tumors (RECIST) version (v) 1.1. The anti-tumor efficacy of each combination will be evaluated by objective response by RECIST v1.1. This analysis will not utilize statistical analysis per standard phase I trials. |
Measure: | Determination of pharmacodynamics markers in tissue, blood, and plasma |
Time Frame: | Up to completion of treatment |
Safety Issue: | |
Description: | Pharmacodynamics markers in tissue, blood, and plasma will be determined that may predict outcome and exploration of the pharmacokinetic profile of each agent when administered in combination. Marker values will be compared between subjects with and without clinical benefit using chi-squared or Fisher exact tests for categorically-scaled markers and Wilcoxon rank sum tests for interval- and ordinal-scaled markers. Due to the large number of candidate markers, only those significant on univariate analysis will be combined into a single logistic regression model to assess their independent effects on clinical benefit. Analyses will be performed both within and across the three cohorts. Results will be considered exploratory and thus no corrections will be made for multiple testing. |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | M.D. Anderson Cancer Center |
Last Updated
January 25, 2021