Clinical Trials /

A Study of MK-1026 in Participants With Selected Hematologic Malignancies

NCT03162536

Description:

This study aims to evaluate the safety, tolerability, pharmacodynamic, and pharmacokinetic (PK) of MK-1026 (formerly ARQ 531) tablets in selected participants with relapsed or refractory hematologic malignancies. No formal hypothesis testing will be performed for this study.

Related Conditions:
  • B-Cell Non-Hodgkin Lymphoma
  • Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma
  • Diffuse Large B-Cell Lymphoma
  • Grade 1 Follicular Lymphoma
  • Grade 2 Follicular Lymphoma
  • Grade 3 Follicular Lymphoma
  • High Grade B-Cell Lymphoma with MYC and BCL2 and/or BCL6 Rearrangements
  • Mantle Cell Lymphoma
  • Marginal Zone Lymphoma
  • Richter Syndrome
  • Waldenstrom Macroglobulinemia
Recruiting Status:

Recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: A Study of MK-1026 in Participants With Selected Hematologic Malignancies
  • Official Title: A Phase 1/2 Dose Escalation Study to Investigate the Safety, Pharmacokinetics, Pharmacodynamics, and Clinical Activity of ARQ 531 in Selected Subjects With Relapsed or Refractory Hematologic Malignancies

Clinical Trial IDs

  • ORG STUDY ID: 1026-001
  • SECONDARY ID: ARQ 531-101
  • SECONDARY ID: MK-1026-001
  • NCT ID: NCT03162536

Conditions

  • Lymphoma, B-Cell
  • Small Lymphocytic Lymphoma
  • Chronic Lymphocytic Leukemia
  • Waldenstrom Macroglobulinemia
  • Mantle Cell Lymphoma
  • Diffuse Large B Cell Lymphoma
  • Richter's Transformation
  • Follicular Lymphoma
  • Marginal Zone Lymphoma

Interventions

DrugSynonymsArms
MK-1026ARQ 531Phase 1: Dose Escalation and Determination of RP2D

Purpose

This study aims to evaluate the safety, tolerability, pharmacodynamic, and pharmacokinetic (PK) of MK-1026 (formerly ARQ 531) tablets in selected participants with relapsed or refractory hematologic malignancies. No formal hypothesis testing will be performed for this study.

Detailed Description

      This study includes 2 parts: Phase 1 (dose escalation) and Phase 2 (dose expansion). In Phase
      1, participants will enroll using 3+3 dose escalation design. The starting dose of MK-1026 in
      oral tablet form was 5mg/day continuously. Dose escalation will continue until the maximum
      tolerated dose (MTD) and/or recommended Phase 2 dose (RP2D) and dosing schedule is reached
      based on protocol-defined dose limiting toxicity (DLT). After the determination of the RP2D,
      9 expansion cohorts will be initiated to evaluate the safety, tolerability, and efficacy of
      MK-1026 at RP2D in participants with specifically defined disease.
    

Trial Arms

NameTypeDescriptionInterventions
Phase 1: Dose Escalation and Determination of RP2DExperimentalPhase I: Dose Escalation and determination of RP2D, multiple dose levels of MK-1026 to be evaluated (Up to approximately 22 months).
  • MK-1026
Phase 2: Expansion Cohort AExperimentalRelapsed/Refractory chronic lymphocytic leukemia/small lymphocytic lymphoma (R/R CLL/SLL) participants with at least 2 prior systemic therapies and previously treated with a covalent Bruton's tyrosine kinase inhibitor (BTKi) who must have a documented BTK mutation on C481 residue receive up to 65 mg of MK-1026 per day orally in each cycle (Cycle length = 28 days) until progressive disease (PD), unacceptable adverse events (AEs), or discontinuation at investigator's discretion (up to approximately 40 months).
  • MK-1026
Phase 2: Expansion Cohort BExperimentalR/R CLL/SLL participants who have failed or were intolerant to a BTKi with documentation of the absence of BTK mutation on C481 residue receive up to 65 mg of MK-1026 per day orally in each cycle (Cycle length = 28 days) until PD, unacceptable AEs, or discontinuation at investigator's discretion (up to approximately 40 months).
  • MK-1026
Phase 2: Expansion Cohort CExperimentalRichter's transformation (RT) participants who have failed at least one prior therapy receive up to 65 mg of MK-1026 per day orally in each cycle (Cycle length = 28 days) until PD, unacceptable AEs, or discontinuation at investigator's discretion (up to approximately 40 months).
  • MK-1026
Phase 2: Expansion Cohort DExperimentalFollicular Lymphoma (FL) participants who have failed at least 2 prior systemic therapies and are histology grade 1, 2, or 3A receive up to 65 mg of MK-1026 per day orally in each cycle (Cycle length = 28 days) until PD, unacceptable AEs, or discontinuation at investigator's discretion (up to approximately 40 months).
  • MK-1026
Phase 2: Expansion Cohort EExperimentalMantle Cell Lymphoma (MCL) participants who have failed at least 2 prior systemic therapies receive up to 65 mg of MK-1026 per day orally in each cycle (Cycle length = 28 days) until PD, unacceptable AEs, or discontinuation at investigator's discretion (up to approximately 40 months).
  • MK-1026
Phase 2: Expansion Cohort FExperimentalMarginal Zone Lymphoma (MZL) participants who have failed at least 2 prior systemic therapies receive up to 65 mg of MK-1026 per day orally in each cycle (Cycle length = 28 days) until PD, unacceptable AEs, or discontinuation at investigator's discretion (up to approximately 40 months).
  • MK-1026
Phase 2: Expansion Cohort GExperimentalHigh-grade B-cell lymphoma (BCL) participants who have failed at least 2 prior systemic therapies and have known MYC and BCL2 and/or BCL6 translocations confirmed by flourescence in situ hybridization (FISH) or overexpression by immunohistochemistry (IHC) receive up to 65 mg of MK-1026 per day orally in each cycle (Cycle length = 28 days) until PD, unacceptable AEs, or discontinuation at investigator's discretion (up to approximately 40 months).
  • MK-1026
Phase 2: Expansion Cohort HExperimentalWaldenström macroglobulinemia (WM) participants who have failed at least 2 prior systemic therapies receive up to 65 mg of MK-1026 per day orally in each cycle (Cycle length = 28 days) until PD, unacceptable AEs, or discontinuation at investigator's discretion (up to approximately 40 months).
  • MK-1026
Phase 2: Expansion Food Effect Cohort IExperimentalB-cell Non-Hodgkin's lymphoma (NHL), CLL/SLL and WM participants receive up to 65 mg of MK-1026 fasted (1 hour prior to or 2 hours after meal) and non-fasted per day orally in each cycle (Cycle length = 28 days) until PD, unacceptable AEs, or discontinuation at investigator's discretion (up to approximately 40 months).
  • MK-1026

Eligibility Criteria

        Inclusion Criteria

        Each prospective participant must meet ALL of the following inclusion criteria in order to
        be eligible for this study:

          -  Signed written informed consent granted prior to initiation of any study-specific
             procedures

          -  For the dose escalation cohorts, relapsed or refractory (R/R) participants with a
             diagnosis of B-cell Non-Hodgkin's lymphoma (NHL), chronic lymphocytic leukemia (CLL)/
             small lymphocytic lymphoma (SLL) and Waldenstrom macroglobulinemia (WM) who have
             received at least two prior systemic therapies . Participants must have failed or are
             intolerant to standard therapies and cannot be a candidate for standard salvage
             regimens. Participants with low grade lymphoma must be progressing and requiring
             treatment

          -  For the expansion cohorts, the following criteria must be met:

               -  Cohort A: R/R CLL/SLL participants with at least 2 prior systemic therapies and
                  previously treated with a covalent Bruton's tyrosine kinase inhibitor (BTKi) who
                  must have a documented Bruton's tyrosine kinase (BTK) mutation on C481 residue

               -  Cohort B: R/R CLL/SLL participants who have failed or were intolerant to a BTKi
                  with documentation of the absence of BTK mutation on C481 residue. In this study,
                  intolerance to standard therapy is defined as having experienced a grade 3 or
                  higher adverse event that was caused by the standard therapy and resulted in
                  treatment discontinuation

               -  Cohort C: Richter's transformation (RT) participants who have failed at least one
                  prior therapy

               -  Cohort D: Follicular Lymphoma (FL) participants who have failed at least 2 prior
                  systemic therapies and are histology grade 1, 2, or 3A

               -  Cohort E: Mantle Cell Lymphoma (MCL) participants who have failed at least 2
                  prior systemic therapies

               -  Cohort F: Marginal Zone Lymphoma (MZL) participants who have failed at least 2
                  prior systemic therapies

               -  Cohort G: High-grade B-cell lymphoma participants who have failed at least 2
                  prior systemic therapies and have known MYC and BCL2 and/or BCL6 translocations

               -  Cohort H: WM participants who have failed at least 2 prior systemic therapies

          -  Disease status requirement:

               -  For CLL participanst symptomatic disease that mandates treatment (Hallek et al.
                  2018)

               -  For B-cell NHL participants, measurable disease by imaging scan

               -  For WM, serum immunoglobulin M (IgM) with a minimum IgM level of ≥ 2 times the
                  upper limit of normal (ULN)

          -  Eastern Cooperative Oncology Group (ECOG) performance status of 0-2

          -  Good organ function

          -  Creatinine clearance of ≥ 60 mL/min as estimated by the Cockcroft-Gault equation or by
             24-hour urine collection

          -  Total bilirubin ≤ 1.5 x institutional ULN (total bilirubin of ≤ 3 x institutional ULN
             in participants with documented Gilbert's syndrome)

          -  Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 2.5 ×
             institutional ULN

          -  Platelet count ≥ 50,000/µL

          -  Absolute neutrophil count (ANC) ≥ 1000/µL

          -  Hemoglobin (Hgb) ≥ 8.0 g/dL, stable for ≥ 1 week.

          -  For men and women of child-bearing potential, willing to use adequate contraception
             (e.g., latex condom, cervical cap, diaphragm, abstinence, etc.) for the entire
             duration of the study

          -  Female participants of child-bearing potential must have a negative serum pregnancy
             test within 14 days of the first day of drug dosing

          -  Ability to swallow oral medications without difficulty

        Exclusion Criteria

        Potential participants who meet ANY of the following exclusion criteria are not eligible
        for enrollment into this study:

          -  Had immunotherapy, radiotherapy, radioimmunotherapy, biological therapy, chemotherapy,
             or treatment with an investigational product within 5 half-lives or four weeks
             (whichever is shorter) prior to treatment initiation, or oral therapy within 5
             half-lives or one week (whichever is shorter) prior to treatment initiation

          -  Transformation of follicular lymphoma (FL) to a more aggressive subtype of lymphoma or
             grade 3b FL

          -  Participants currently being treated with the following drugs:

               -  cytochrome P 450 (CYP) 2C9 substrates with a narrow therapeutic index (such as
                  warfarin, phenytoin)

               -  CYP 2C8 substrates with a narrow therapeutic index (such as paclitaxel)

               -  CYP 2C19 substrates with a narrow therapeutic index (such as S-mephenytoin)

               -  CYP 2D6 substrates with a narrow therapeutic index (such as thioridazine,
                  pimozide)

               -  P-gp substrates with a narrow therapeutic index (such as digoxin) Note: A washout
                  period of at least 5 times the half-life after the last dose of any of the above
                  treatments is required for a participant to be eligible for study enrollment

          -  Prior allogeneic bone marrow transplant

          -  Active central nervous system (CNS) involvement

          -  Pregnant or breast-feeding women

          -  Has significant, ongoing co-morbid conditions which would preclude safe delivery of
             the study drug

          -  Uncontrolled illness including but not limited to ongoing or active infection,
             symptomatic congestive heart failure (New York Heart Association [NYHA] Class III or
             IV heart failure), unstable angina pectoris, cardiac arrhythmia, cardiac infarction in
             the past six months, and psychiatric illness that would limit compliance with study
             requirements

          -  QT corrected (QTc) prolongation (defined as a QTc > 450 msecs) or other significant
             electrocardiogram (ECG) abnormalities including 2nd degree atrioventricular (AV) block
             type II, 3rd degree AV block, or bradycardia (ventricular rate less than 50
             beats/min). If the screening ECG has a QTc > 450 msecs, the ECG can be submitted for a
             centralized, cardiologic evaluation.

          -  Active human immunodeficiency virus (HIV) infection, Hepatitis B, or Hepatitis C
             infection.

          -  Other medical or psychiatric illness or organ dysfunction which, in the opinion of the
             Investigator, would either compromise the participant's safety or interfere with the
             evaluation of the safety of the study agent

          -  History of prior cancer within < 1 year, except for basal cell or squamous cell
             carcinoma of the skin, cervical cancer in situ or other in situ carcinomas
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Phase 1: Number of Participants Experiencing Dose Limiting Toxicity (DLT)
Time Frame:Cycle 1 (up to 28 days)
Safety Issue:
Description:DLT is defined by the occurrence of any of the following treatment emergent adverse event (TEAE) unless unequivocally due to the underlying malignancy or an extraneous cause within the first 28 days of study treatment (for dose escalation only) and graded according to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 4.03. Any Grade 5 TEAE, any Grade 3 nonhematological TEAE except alopecia, nausea, vomiting, diarrhea, and transient Grade 3 laboratory abnormalities which recover within 1 week without intervention, any Grade 3 hematological TEAE that does not recover to Grade 1 or baseline within 7 days with the exception of Grade 3 lymphocytosis, which is considered to be an expected outcome of BTK inhibition, any Grade 4 nonhematological and hematological TEAE, or any other toxicity that in the view of the investigator represents a clinically significant hazard to the participant.

Secondary Outcome Measures

Measure:Phase 2: Number of Participants Who Experienced an AE
Time Frame:Up to approximately 40 months
Safety Issue:
Description:An AE is any untoward medical occurrence in a clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of a study intervention. The number of participants who experienced an AE will be reported.
Measure:Phase 2: Number of Participants Who Discontinued Study Treatment Due to an AE
Time Frame:Up to approximately 39 months
Safety Issue:
Description:An AE is any untoward medical occurrence in a clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of a study intervention. The number of participants who discontinued study treatment due to an AE will be reported.
Measure:Time to Maximum Concentration (Tmax) of MK-1026
Time Frame:Cycle 1: Days 1, 7 (Cohort I only), 8 (Cohort I only) & Cycle 2: Day 1: Predose and 1, 2, 4, 8, 24 hours postdose; Cycle 3: Day 1: Predose and 2 hours postdose (cycle length = 28 days)
Safety Issue:
Description:Blood samples will be collected at prespecified time points to determine Tmax of MK-1026.
Measure:Maximum Concentration (Cmax) of MK-1026
Time Frame:Cycle 1: Days 1, 7 (Cohort I only), 8 (Cohort I only) & Cycle 2: Day 1: Predose and 1, 2, 4, 8, 24 hours postdose; Cycle 3: Day 1: Predose and 2 hours postdose (cycle length = 28 days)
Safety Issue:
Description:Blood samples will be collected at prespecified time points to determine Cmax of MK-1026.
Measure:Area Under the Concentration-Time Curve From Time Zero to 24 Hours (AUC 0-24hrs)of MK-1026
Time Frame:Cycle 1: Days 1, 7 (Cohort I only), 8 (Cohort I only) & Cycle 2: Day 1: Predose and 1, 2, 4, 8, 24 hours postdose; Cycle 3: Day 1: Predose and 2 hours postdose (cycle length = 28 days)
Safety Issue:
Description:Blood samples will be collected at prespecified time points to determine AUC 0-24hrs of MK-1026.
Measure:Terminal Elimination Half-Life (t1/2) of MK-1026
Time Frame:Cycle 1: Days 1, 7 (Cohort I only), 8 (Cohort I only) & Cycle 2: Day 1: Predose and 1, 2, 4, 8, 24 hours postdose; Cycle 3: Day 1: Predose and 2 hours postdose (cycle length = 28 days)
Safety Issue:
Description:t1/2 is the time it takes for the concentration of MK-1026 in the body to decrease by half during the elimination phase.
Measure:Phase 2: Expansion Cohorts D-H: ORR per iwCLL Criteria as Assessed by the Investigator
Time Frame:Up to approximately 40 months
Safety Issue:
Description:ORR is defined as the percentage of participants achieving a best overall response of complete response (CR), partial response (PR) or partial response with lymphocytosis (PRL). iwCLL criteria as assessed by the investigator. CR is defined as meeting the following criteria: no lymph nodes >1.5 cm, spleen size <13 cm, liver normal; no constitutional symptoms, normal lymphocyte count, platelets ≥100 x 10^9/L; hemoglobin ≥11 g/dL; and normocellular marrow (no CLL cells or B lymphoid nodules). PR is defined as ≥50% decrease in ≥2 of the following: lymph nodes, liver and/or spleen size, lymphocytes PLUS ≥1 of the following met: platelets ≥100 x 10^9/L or ≥50% increase from screening, hemoglobin >11 g/dL or ≥50% increase from screening, CLL cells or B lymphoid nodules in marrow.
Measure:Phase 2: Expansion Cohorts D-H: ORR per Lugano classification as Assessed by the Investigator
Time Frame:Up to approximately 40 months
Safety Issue:
Description:ORR is defined as percentage of participants achieving best overall response of CR/PR per Lugano classification as assessed by investigator. CR defined as EITHER CR by imaging (computed tomography [CT]): all lymph nodes normal (none ≥15 mm) & normal liver, spleen OR complete metabolic response (CMR): score of 1, 2 or3 on 5-point scale assessing fluorodeoxyglucose (FDG) metabolic activity in lymphomatous lesions (range: 1=no uptake above background to 5=uptake markedly higher than liver) AND bone marrow (BM) normal by morphology. PR defined as EITHER PR by imaging (CT) with ≥50% decrease in sum of product of diameters [SPD] of target lesions, no worsening of nontarget lesions, no new lesions and ≥50% spleen abnormal portion OR Partial Metabolic Response (PMR) with score of 4/5 on FDG 5-point scale (with no new lesions) & decreased overall uptake AND residual BM abnormalities; OR CR by imaging with residual BM abnormalities; OR PR by imaging without residual BM abnormalities.
Measure:Phase 2: Expansion Cohorts A, B, H: Duration of Response (DOR) per iwCLL Criteria as Assessed by the Investigator
Time Frame:Up to approximately 40 months
Safety Issue:
Description:DOR is defined as the time from the first documented evidence of CR or PR (or PRL for CLL/SLL participants) until progressive disease or death due to any cause, whichever occurs first. CR is defined as meeting the following criteria: no lymph nodes >1.5 cm, spleen size <13 cm, liver normal; no constitutional symptoms, normal lymphocyte count, platelets ≥100 x 10^9/L; hemoglobin ≥11 g/dL; and normocellular marrow (no CLL cells or B lymphoid nodules). PR is defined as ≥50% decrease in ≥2 of the following: lymph nodes, liver and/or spleen size, lymphocytes PLUS ≥1 of the following met: platelets ≥100 x 10^9/L or ≥50% increase from screening, hemoglobin >11 g/dL or ≥50% increase from screening, CLL cells or B lymphoid nodules in marrow.
Measure:Phase 2: Expansion Cohorts C-G: DOR per Laguna Classification As Assessed by Investiigator
Time Frame:Up to approximately 40 months
Safety Issue:
Description:DOR is defined as time from first documented evidence of CR/PR (or PRL for CLL/SLL participants) until progressive disease or death due to any cause, whichever occurs first. CR defined as EITHER CR by imaging (computed tomography [CT]): all lymph nodes normal (none ≥15 mm) & normal liver, spleen OR complete metabolic response (CMR): score of 1, 2 or3 on 5-point scale assessing FDG metabolic activity in lymphomatous lesions (range: 1=no uptake above background to 5=uptake markedly higher than liver) AND BM normal by morphology. PR defined as EITHER PR by imaging (CT) with ≥50% decrease in SPD of target lesions, no worsening of nontarget lesions, no new lesions and ≥50% spleen abnormal portion OR PMR with score of 4/5 on FDG 5-point scale (with no new lesions) & decreased overall uptake AND residual BM abnormalities; OR CR by imaging with residual BM abnormalities; OR PR by imaging without residual BM abnormalities.

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:ArQule, Inc. (a wholly owned subsidiary of Merck Sharp and Dohme, a subsidiary of Merck & Co., Inc.)

Trial Keywords

  • ARQ 531
  • Hematologic Malignancies
  • SLL
  • CLL
  • B-cell NHL
  • WM
  • BTK (Bruton's tyrosine kinase)
  • cancer
  • refractory
  • relapsed
  • Acalabrutinib
  • ArQule
  • BGB-3111
  • Blood Protein Disorders
  • Follicular Lymphoma
  • BTK Intolerant
  • C481
  • C481S
  • C481S Mutation
  • Cardiovascular Diseases
  • Chronic Lymphocytic Leukemia
  • DLBCL (Diffuse Large B-cell lymphoma)
  • GS-4059
  • Hemorrhagic Disorders
  • Hemostatic Disorders
  • Ibrutinib
  • Immune System Diseases
  • Immunoproliferative Disorders
  • Leukemia
  • Leukemia, B-Cell
  • Leukemia, Lymphocytic, Chronic, B-Cell
  • Leukemia, Lymphoid
  • Lymphatic Diseases
  • Lymphoma
  • Lymphoma, B-Cell
  • Lymphoma, B-Cell, Marginal Zone
  • Lymphoma, Mantle-Cell
  • Lymphoma, Non-Hodgkin
  • Lymphoproliferative Disorders
  • Mantle Cell Lymphoma
  • Marginal zone lymphoma
  • Neoplasms
  • Neoplasms by Histologic Type
  • Neoplasms, Plasma Cell
  • NHL (Non-Hodgkin's Lymphoma)
  • ONO-4059
  • Paraproteinemias
  • Small Lymphocytic Lymphoma
  • Tirabrutinib
  • Vascular Diseases
  • Waldenstrom Macroglobulinemia
  • Zanubrutinib

Last Updated

August 5, 2021