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A Study of CA-4948 in Patients With Relapsed or Refractory Hematologic Malignancies

NCT03328078

Description:

This is a multi-center, open-label trial to evaluate oral administration of CA-4948 in adult patients with relapsed/refractory hematologic malignancies. Part A will evaluate escalating doses of CA-4948 either as monotherapy (Part A1) or in combination with ibrutinib for non- Hodgkin's Lymphoma (NHL), macroglobulinemia/lymphoplasmacytic lymphoma (WM/LPL) and chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) (Part A2). Once the combination dose has been determined, Part B will comprise an expansion phase to assess efficacy (CR rate) and safety of the RP2D of CA-4948 and ibrutinib in 4 Non-Hodgkin Lymphoma (NHL) disease-specific cohorts: - Cohort 1 - Marginal zone lymphoma (MZL) - Cohort 2 - activated B-cell (ABC) diffuse large B-cell lymphoma (DLBCL) or extranodal subtypes: Leg-, testicular-, or not otherwise specified (NOS)-type - Cohort 3 - Primary central nervous system lymphoma (PCNSL) - Cohort 4 - Patients receiving ibrutinib monotherapy who have developed adaptive, secondary resistance. Indications include: - Mantle Cell Lymphoma (MCL), MZL, CLL/SLL, or WM/LPL - Indications for which ibrutinib is National Comprehensive Cancer Network (NCCN)-listed (e.g., PCNSL) - Patients with NHL and known myddosome mutations - Patients may be candidates for maintaining ibrutinib while CA-4948 will be added for resistance reversal. A brief gap of ibrutinib therapy of <3 weeks is acceptable.

Related Conditions:
  • Acute Myeloid Leukemia
  • Acute Promyelocytic Leukemia
  • B-Cell Non-Hodgkin Lymphoma
Recruiting Status:

Recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: A Study of CA-4948 in Patients With Relapsed or Refractory Hematologic Malignancies
  • Official Title: An Open-Label, Dose Escalation and Dose Expansion Trial Evaluating the Safety, Pharmacokinetics, Pharmacodynamics, and Clinical Activity of Orally Administered CA-4948 in Patients With Relapsed or Refractory Hematologic Malignancies

Clinical Trial IDs

  • ORG STUDY ID: CA-4948-101
  • NCT ID: NCT03328078

Conditions

  • Relapsed Hematologic Malignancy
  • Refractory Hematologic Malignancy

Interventions

DrugSynonymsArms
CA-4948CA-4948 and ibrutinib dose escalation
ibrutinibCA-4948 and ibrutinib dose escalation

Purpose

This is a multi-center, open-label trial to evaluate oral administration of CA-4948 in adult patients with relapsed/refractory hematologic malignancies. Part A will evaluate escalating doses of CA-4948 either as monotherapy (Part A1) or in combination with ibrutinib for non- Hodgkin's Lymphoma (NHL), macroglobulinemia/lymphoplasmacytic lymphoma (WM/LPL) and chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) (Part A2). Once the combination dose has been determined, Part B will comprise an expansion phase to assess efficacy (CR rate) and safety of the RP2D of CA-4948 and ibrutinib in 4 Non-Hodgkin Lymphoma (NHL) disease-specific cohorts: - Cohort 1 - Marginal zone lymphoma (MZL) - Cohort 2 - activated B-cell (ABC) diffuse large B-cell lymphoma (DLBCL) or extranodal subtypes: Leg-, testicular-, or not otherwise specified (NOS)-type - Cohort 3 - Primary central nervous system lymphoma (PCNSL) - Cohort 4 - Patients receiving ibrutinib monotherapy who have developed adaptive, secondary resistance. Indications include: - Mantle Cell Lymphoma (MCL), MZL, CLL/SLL, or WM/LPL - Indications for which ibrutinib is National Comprehensive Cancer Network (NCCN)-listed (e.g., PCNSL) - Patients with NHL and known myddosome mutations - Patients may be candidates for maintaining ibrutinib while CA-4948 will be added for resistance reversal. A brief gap of ibrutinib therapy of <3 weeks is acceptable.

Trial Arms

NameTypeDescriptionInterventions
CA-4948 dose escalationExperimentalPart A1: Dose-level cohorts with up to 6 patients each will be used to define the Maximum Tolerated Dose (MTD) for CA-4948.
  • CA-4948
CA-4948 and ibrutinib dose escalationExperimentalPart A2: Evaluate escalating dose levels of oral CA-4948 in combination with 560 mg daily (QD) of oral ibrutinib (or 420 mg QD for WM/LPL and CLL/SLL). Separate escalation will be performed for each of these ibrutinib doses. The starting dose of CA-4948 to be used in combination will be 200 mg twice a day (BID). It is anticipated that 12 to 18 patients will be required to establish optimal combination dosing.
  • CA-4948
  • ibrutinib
CA-4948 and ibrutinib dose expansionExperimentalIn expansion phase, the CA-4948 recommended Phase 2 dose (RP2D) in combination with ibrutinib will be administered in Non-Hodgkin Lymphoma (NHL) disease-specific cohorts. Up to 46 NHL patients will be enrolled in each of the following 4 NHL disease-specific cohorts: Cohort 1 - Marginal zone lymphoma (MZL) Cohort 2 - ABC diffuse large B-cell lymphoma (DLBCL) or extranodal subtypes: Leg-, testicular-, or NOS-type Cohort 3 - Primary central nervous system lymphoma (PCNSL) Cohort 4 - Patients receiving ibrutinib monotherapy who have developed adaptive, secondary resistance. Indications include: Mantle Cell Lymphoma (MCL), MZL, CLL/SLL, or WM/LPL Indications for which ibrutinib is National Comprehensive Cancer Network (NCCN)-listed (e.g., PCNSL) Patients with NHL and known myddosome mutations Patients may be candidates for maintaining ibrutinib while CA-4948 will be added for resistance reversal. A brief gap of ibrutinib therapy of <3 weeks is acceptable.
  • CA-4948
  • ibrutinib

Eligibility Criteria

        Inclusion Criteria:

          1. Males and females greater than or equal to 18 years of age

          2. Life expectancy of at least 3 months

          3. Eastern Cooperative Oncology Group (ECOG) Performance Status of ≤ 1

          4. For Part A1: Diagnosis of histopathologically confirmed B-cell hematological
             malignancy (as per the World Health Organization [WHO] 2016 classification; Swedow
             2016); eligible subtypes include follicular lymphoma, MZL, DLBCL, mantle cell
             lymphoma, lymphoplasmacytic lymphoma, and WM/LPL without the urgent need for treatment
             hyperviscosity.

             For Part A2: Diagnosis of histopathologically confirmed B-cell NHL, as per the WHO
             2016 classification (Swerdlow et al. 2016). Eligible NHL subtypes include follicular
             lymphoma, MZL, mantle cell lymphoma, DLBCL(including extranodal lymphomas of leg-,
             testicular-, or NOS type), CLL/SLL, primary or secondary CNS lymphoma and Waldenström
             macroglobulinemia / LPL.

             For Part B: Diagnosis of histopathologically confirmed B-cell NHLs, including
             applicable confirmation as per the WHO 2016 classification (Swerdlow et al. 2016):

               -  Cohort 1: Marginal zone lymphoma

               -  Cohort 2: ABC-DLBCL, or extranodal subtypes: Leg-, testicular-, or NOS-type. The
                  population will be enriched for MYD88 L265P mutations. As this occurs more
                  frequently in the ABC-DLBCL(activated B-cell (Hans et al. 2004) subtype, all
                  patients with this subtype qualify for enrollment. If the MYD88 mutation status
                  is unknown at baseline, the lymphoma will be tested for MYD88 mutations.

               -  Cohort 3: Primary CNS Lymphoma (PCNSL) only. If the MYD88 mutation status is
                  unknown at baseline, the lymphoma will be tested for MYD88 mutations.

               -  Cohort 4: Patients receiving ibrutinib monotherapy who have developed adaptive,
                  secondary resistance. Indications include:

                    -  MCL, MZL, CLL/SLL, or WM/LPL

                    -  Indications for which ibrutinib is NCCN-listed (e.g., PCNSL)

                    -  Patients with NHL and known myddosome mutations

                    -  Patients may be candidates for maintaining ibrutinib while CA-4948 will be
                       added for resistance reversal. A brief gap of ibrutinib therapy of <3 weeks
                       is acceptable.

          5. Relapsed or refractory measurable disease for which patients are ineligible for or
             have exhausted standard therapeutic options that would be considered standard of care

        Exclusion Criteria:

          1. Active central nervous system (CNS) involvement other than PCNSL (Part A2 or B) or
             secondary CNS lymphoma (Part B only).

          2. Radiotherapy delivered to non-target lesions involving >25% of bone marrow within one
             week prior to starting study treatment or delivered to target lesions that will be
             followed on the study (NOTE: prior sites of radiation will be recorded)

          3. Any prior anti-cancer treatment such as chemotherapy, immunomodulatory drug therapy,
             etc., received within 14 days prior to start of study treatment (with the exception of
             ibrutinib for Parts A2 and B, which may be continued as part of this study without
             interruption)

          4. Current or planned glucocorticoid therapy, with the following exceptions:

               1. Doses ≤ 10 mg/day prednisolone or equivalent is allowed, provided that the
                  steroid dose has been stable or tapering for at least 14 days prior to the first
                  dose of study treatment

               2. Inhaled, intranasal, intraarticular and topical steroids are permitted

          5. Use of any investigational agent within 21 days or 5 half-lives, whichever is shorter,
             prior to start of study treatment

          6. Presence of an acute or chronic toxicity resulting from prior anti-cancer therapy,
             with the exception of alopecia, that has not resolved to Grade ≤ 1 within 7 days prior
             to start of study treatment unless approved by the Medical Monitor

          7. Known allergy or hypersensitivity to any component of the formulation of CA-4948 (or
             ibrutinib for entry into Parts A2 or B) used in this study

          8. B-cell NHL of the following subtypes:

               1. Burkitt lymphoma

               2. Lymphoblastic lymphoma or leukemia

               3. Post-transplantation lymphoproliferative disorder

               4. Known primary mediastinal, ocular, or epidural, DLBCL

               5. WM patients requiring urgent treatment due to hyperviscosity
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:To determine the safety and tolerability of CA-4948 as a monotherapy and in combination with ibrutinib: dose-limiting toxicity (DLT)
Time Frame:12 months
Safety Issue:
Description:The number of patients with a dose-limiting toxicity (DLT) in the first treatment cycle

Secondary Outcome Measures

Measure:Pharmacokinetic (PK) profile of CA-4948 measured by AUC
Time Frame:24- 36 months
Safety Issue:
Description:Area Under the concentration-time curve (AUC)
Measure:Pharmacokinetic (PK) profile of CA-4948 measured by Cmax
Time Frame:24- 36 months
Safety Issue:
Description:Maximum plasma concentration (Cmax)
Measure:Pharmacokinetic (PK) profile of CA-4948 measured by Cmin
Time Frame:24- 36 months
Safety Issue:
Description:Trough plasma concentration (Cmin)
Measure:Pharmacokinetic (PK) profile of CA-4948 measured by Tmax
Time Frame:24- 36 months
Safety Issue:
Description:Time to maximum plasma concentration (Tmax)
Measure:Pharmacokinetic (PK) profile of CA-4948 measured by plasma terminal half-life
Time Frame:24- 36 months
Safety Issue:
Description:Plasma terminal elimination half-life (T 1/2)
Measure:To assess efficacy of CA-4948 as a monotherapy and in combination with ibrutinib measured by overall response rate (ORR)
Time Frame:24- 36 months
Safety Issue:
Description:Assessed by ORR
Measure:To assess efficacy of CA-4948 as a monotherapy and in combination with ibrutinib measured by duration of response (DOR)
Time Frame:24- 36 months
Safety Issue:
Description:Assessed by DOR
Measure:To assess efficacy of CA-4948 as a monotherapy and in combination with ibrutinib measured by disease control rate (DCR)
Time Frame:24- 36 months
Safety Issue:
Description:Assessed by DCR
Measure:To assess efficacy of CA-4948 as a monotherapy and in combination with ibrutinib measured by progression free survival (PFS)
Time Frame:24- 36 months
Safety Issue:
Description:Assessed by PFS
Measure:To assess efficacy of CA-4948 as a monotherapy and in combination with ibrutinib measured by overall survival (OS)
Time Frame:24 - 36 months
Safety Issue:
Description:Assessed by OS
Measure:Part B: To estimate the blood-brain barrier penetration in CNS lymphoma patients
Time Frame:1 day
Safety Issue:
Description:CNS liquor with be sampled from an Ommaya reservoir or with a spinal puncture about 3 hours after oral dosing of CA-4948. At approximately the same timepoint, a peripheral blood sample will be taken to obtain a plasma sample. The respective CA-4948 concentrations will be measured in the liquor and in plasma samples. The liquor vs plasma concentration ratio will provide a rough estimate of the blood-brain barrier (BBB) penetration of CA-4948 following oral dosing.

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Curis, Inc.

Trial Keywords

  • DLBCL
  • MCL
  • WM
  • LPL
  • MYD88
  • IRAK4
  • NHL
  • AML
  • CLL
  • SLL
  • MZL
  • PCNSL

Last Updated

May 5, 2021