Description:
Many patients have cancers that have increased activity of a protein called STAT3 that
contributes critically to the development and growth of their cancer. Despite our knowledge
of STAT3's importance to cancer, scientists and doctors have not developed a drug that
targets it and that patients can take to treat their cancer more effectively than treatments
that are now available. Tvardi Therapeutics, Incorporated has developed a compound, TTI-101,
which can be given by mouth and acts as a direct inhibitor of STAT3. Administration of
TTI-101 to mice demonstrated that it blocked growth of cancers of the breast, head and neck,
lung, and liver and it was safe when administered at high doses to mice, rats, and dogs. In
this application, Tvardi is proposing to further develop TTI-101 for treatment of solid
tumors for which the prognosis is dismal. The investigators will determine how safe it is
when administered to patients with cancer, determine whether an adequate dose can be
administered to patients with cancer that will block STAT3 in their cancer, and determine
whether treatment with TTI-101 leads to reduced growth of their cancer.
Title
- Brief Title: Oral STAT3 Inhibitor, TTI-101, in Patients With Advanced Cancers
- Official Title: Phase I Study of TTI-101, an Oral Inhibitor of Signal Transducer and Activator of Transcription (STAT) 3, in Patients With Advanced Cancers
Clinical Trial IDs
- ORG STUDY ID:
SM_CP2016-0842
- NCT ID:
NCT03195699
Conditions
- Breast Cancer
- Head and Neck Squamous Cell Carcinoma
- Non Small Cell Lung Cancer
- Hepatocellular Cancer
- Colorectal Cancer
- Gastric Adenocarcinoma
- Melanoma
- Advanced Cancer
Interventions
Drug | Synonyms | Arms |
---|
TTI-101 | | Dose escalation study |
Purpose
Many patients have cancers that have increased activity of a protein called STAT3 that
contributes critically to the development and growth of their cancer. Despite our knowledge
of STAT3's importance to cancer, scientists and doctors have not developed a drug that
targets it and that patients can take to treat their cancer more effectively than treatments
that are now available. Tvardi Therapeutics, Incorporated has developed a compound, TTI-101,
which can be given by mouth and acts as a direct inhibitor of STAT3. Administration of
TTI-101 to mice demonstrated that it blocked growth of cancers of the breast, head and neck,
lung, and liver and it was safe when administered at high doses to mice, rats, and dogs. In
this application, Tvardi is proposing to further develop TTI-101 for treatment of solid
tumors for which the prognosis is dismal. The investigators will determine how safe it is
when administered to patients with cancer, determine whether an adequate dose can be
administered to patients with cancer that will block STAT3 in their cancer, and determine
whether treatment with TTI-101 leads to reduced growth of their cancer.
Detailed Description
Signal transducer and activator of transcription 3 (STAT3) is a member of a family of seven
closely related proteins responsible for transmission of peptide hormone signals from the
extracellular surface of cells to the nucleus. STAT3 is a master regulator of most key
hallmarks and enablers of cancer, including cell proliferation, resistance to apoptosis,
metastasis, immune evasion, tumor angiogenesis, epithelial mesenchymal transition (EMT),
response to DNA damage, and the Warburg effect. STAT3 also is a key mediator of oncogene
addiction and supports the self-renewal of tumor-initiating cancer stem cells that contribute
to cancer initiation, cancer maintenance, and relapse in several types of tumors. STAT3
activity is increased in ~50% of all cancers, due either to naturally occurring STAT3
mutations, as have been demonstrated in human inflammatory hepatocellular adenomas and large
granular lymphocytic leukemia, or, more commonly as a result of activation of signaling
molecules upstream of STAT3, including receptor tyrosine kinases (RTK; e.g. epidermal growth
factor receptor, EGFR), tyrosine kinase-associated receptors (e.g. the family of IL-6
cytokine receptors or G-protein coupled receptors, GPCR), and Src kinases (e.g. Src, Lck,
Hck, Lyn, Fyn, or Fgr). Thus, STAT3 is an attractive target for drug development to treat
many types of cancer including breast cancer, head and neck squamous cell carcinoma (HNSCC),
non-small cell lung cancer (NSCLC), hepatocellular carcinoma (HCC), colorectal cancer (CRC),
gastric adenocarcinoma and melanoma.
Trial Arms
Name | Type | Description | Interventions |
---|
Dose escalation study | Experimental | In a 3 + 3 cohort design, three patients are initially enrolled into a given dose cohort. If there is no DLT observed in any of the first three subjects, the trial proceeds with enrolling additional subjects into the next higher dose cohort. If one subject develops a DLT at a specific dose, an additional three subjects are enrolled into that same dose cohort. Development of DLTs in >1 of 6 subjects in a specific dose cohort will determine the MTD and no further dose escalation is done.
Dose Level/TTI-101 (mg/kg/day) administered in divided doses every 12 hours 1/3.2 2/6.4 3/12.8 4/25.6
At the end of the dose escalation phase of the study, the investigators will determine the characteristics of the patients who will be enrolled at the expansion phase of the study. | |
Eligibility Criteria
Inclusion Criteria
All of the following inclusion criteria must be fulfilled for eligibility:
1. Age ≥18 years;
2. For patients with solid tumors (not unresectable HCC): Patients with histologically
confirmed diagnosis of locally-advanced, inoperable, metastatic and/or treatment
refractory solid tumors for whom there are no available therapies that will confer
clinical benefit;
3. For patients with unresectable HCC: Patients with histologically confirmed diagnosis
of locally advanced, inoperable, unresectable HCC who have failed first and second
lines of therapy and Child-Pugh is A or beyond second line if the performance status
is preserved and Child-Pugh is A.
4. Eastern Cooperative Oncology Group Performance status 0-1;
5. Hemoglobin ≥9.0 g/dL, neutrophil count ≥1.0 x 109/l, platelets ≥100 x 109/L;
6. Adequate renal function capability, as calculated by creatinine clearance >40 ml/min
using the Cockroft-Gault formula;
7. Adequate liver function defined as total bilirubin <1.5 x ULN, and aspartate
aminotransferase (AST)/alanine aminotransferase (ALT) <3 x ULN. For subjects with
liver involvement, AST/ALT <5 x ULN; For subjects with liver involvement, AST/ALT <5 x
ULN;
8. Measurable disease using clinically appropriate criteria for the type of malignancy,
RECIST v 1.1 for solid tumors;
9. Negative blood pregnancy test at the screening visit for women of childbearing
potential, defined as: female subjects after puberty unless they have been
postmenopausal for at least two years, are surgically sterile, or are sexually
inactive and will remain so for the course of the trial;
10. Willingness to avoid pregnancy and breast feeding beginning two weeks before the first
TTI-101 dose and ending three months after the last trial treatment. Male subjects
with female partners of childbearing potential and female subjects of childbearing
potential must use adequate contraception in the judgment of the Investigator, such as
a two-barrier method or a one-barrier method with spermicide or intrauterine device
during trial treatment dosing and for 3 months after the last dose of the study; and
11. Ability to read and understand the informed consent form and willingness and ability
to give informed consent and demonstrate comprehension of the trial before undergoing
any trial activities.
Exclusion Criteria
Subjects are ineligible to enroll in this trial if they fulfill any of the following
exclusion criteria:
1. Previous therapy with:
1. Standard therapy including chemotherapy, immunotherapy, biologic therapy, or any
other anticancer therapy within 28 days (or five elimination half-lives for
non-cytotoxic drugs, whichever is shorter) of Day 1 of trial drug treatment (6
weeks for nitrosureas or mitomycin);
2. Any investigational agent within 28 days of Day 1 of trial drug treatment or 5
half-lives for a small molecule/targeted therapy;
2. Extensive prior radiotherapy on more than 30% of bone marrow reserves, or prior bone
marrow/stem cell transplantation within 5 years from enrollment; Ongoing toxicity
(except alopecia) due to a prior therapy, unless returned to baseline or Grade 1 or
less;
3. Major surgical intervention or participation in a therapeutic clinical trial within 28
days from Day 1 of the first dose of TTI-101;
4. Significantly impaired cardiac function such as unstable angina pectoris, congestive
heart failure with New York Heart Association (NYHA) class III or IV, myocardial
infarction within the last 12 months prior to trial entry; signs of pericardial
effusion, serious arrhythmia (including QTc prolongation of >470 ms and/or pacemaker)
or prior diagnosis of congenital long QT syndrome or left ventricular ejection
fraction <50% on screening echocardiogram;
5. History of cerebral vascular accident or stroke within the previous 2 years;
6. Uncontrolled hypertension (>160/100mm Hg);
7. History of Grade 3 or 4 allergic reactions attributed to compounds of similar chemical
or biologic composition as TTI-101 (hydroxyl-naphthalene sulfonamides);
8. Known active metastases in the central nervous system (unless stable by brain imaging
studies for at least 1 month without evidence of cerebral edema and no requirements
for corticosteroids or anticonvulsants);
9. History of difficulty swallowing, malabsorption, or other chronic gastrointestinal
disease or conditions that may hamper compliance and/or absorption of the
investigational product;
10. Known human immunodeficiency virus;
11. Subjects with chronic hepatitis B virus (HBV) infection, unless screening viral load
<100 IU/mL on stable doses of antiviral therapy. Note: Subjects with chronic HCV
infection are allowed to enroll in the study but do not have a defined maximum viral
load requirement for study entry;
12. Legal incapacity or limited legal capacity;
13. Pregnant or lactating women;
14. Any other condition, which in the opinion of the investigator, might impair the
subject's tolerance of trial treatment, the safety of the individual subject, or the
outcome of the trial;
15. Previous treatment of the current malignancy with a STAT inhibitor.
Maximum Eligible Age: | 65 Years |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Maximum Tolerated Dose of TTI-101 |
Time Frame: | 6 months |
Safety Issue: | |
Description: | To determine the maximum tolerated dose (MTD), dose-limiting toxicities, and tolerability of TTI-101 administered orally to patients with advanced breast cancer and other solid tumors. Dose-limiting toxicity is defined as a Grade 3 or above adverse event (using CTCAE v5.0) within the first treatment cycle (28-days). |
Secondary Outcome Measures
Measure: | Pharmacodynamics of TTI-101 in patients |
Time Frame: | 6 months |
Safety Issue: | |
Description: | Levels of pY-STAT3 measured before and before and after receiving TTI-101 will be measured. |
Measure: | Complete Response (CR) - Target Lesions |
Time Frame: | 6 months |
Safety Issue: | |
Description: | Complete Response (CR): Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to <10 mm. |
Measure: | Partial Response (PR) - Target Lesions |
Time Frame: | 6 months |
Safety Issue: | |
Description: | Partial Response (PR): At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. |
Measure: | Progressive Disease (PD) - Target Lesions |
Time Frame: | 6 months |
Safety Issue: | |
Description: | Progressive Disease (PD): At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progression). |
Measure: | Stable Disease (SD) - Target Lesions |
Time Frame: | 6 months |
Safety Issue: | |
Description: | Stable Disease (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study. |
Measure: | Complete Response (CR) - Non-target Lesions |
Time Frame: | 6 months |
Safety Issue: | |
Description: | Complete Response (CR): Disappearance of all non-target lesions and normalization of tumor marker level. All lymph nodes must be non-pathological in size (<10 mm short axis). |
Measure: | Non-CR/Non-PD - Non-target Lesions |
Time Frame: | 6 months |
Safety Issue: | |
Description: | Non-CR/Non-PD: Persistence of one or more non-target lesion(s) and/or maintenance of tumor marker level above the normal limits. |
Measure: | Progressive Disease (PD) - Non-target Lesions |
Time Frame: | 6 months |
Safety Issue: | |
Description: | Progressive Disease (PD): Unequivocal progression of existing non-target lesions. (Note: the appearance of one or more new lesions is also considered progression). |
Measure: | Best Overall Response |
Time Frame: | 6 months |
Safety Issue: | |
Description: | The best overall response is the best response recorded from the start of the study treatment until the end of treatment, taking into account any requirement for confirmation. The patient's best overall response assignment will depend on the findings of both target and non-target disease and will also take into consideration the appearance of new lesions. |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Tvardi Therapeutics, Incorporated |
Trial Keywords
- STAT3, cancer, inhibitor, advanced cancer
Last Updated
July 27, 2021