This is a Phase 1, open-label, multicenter study of KPG-121 administered orally once daily
(QD) in 28-day treatment cycles (21 days on and 7 days off) to adult subjects. The primary
objective is to determine the maximum tolerated dose (MTD) and recommended Phase 2 dose
(RP2D) and assess dose-limiting toxicity (DLT) of KPG-121 in combination with Enzalutamide or
Abiraterone or Apalutamide when administered orally to adult subjects with non-metastatic or
metastatic castration-resistant prostate cancer (CRPC).
This Phase 1 study will comprise two parts: Part 1 will be a 3+3 dose escalation design to
characterize the MTD and a RP2D, Part 2 will be an expansion cohort at RP2D. In Part 1,
multiple escalating dose levels of KPG-121 (six cohorts: 1.5, 2.5, 5.0, 10, 20, and 30
mg/day) in combination with Enzalutamide or Abiraterone or Apalutamide will be evaluated to
determine the MTD and RP2D of KPG-121. A RP2D will be selected based on the MTD as well as
the information including safety, efficacy, and PSA data. The Part 2 will follow the same
schedule of procedures as Part 1 once the RP2D has been decided. For the expansion cohort of
part 2, subjects will be given the RP2D once daily for 21 consecutive days along with
Enzalutamide or Abiraterone or Apalutamide followed by 7 days without KPG-121 for each 28-day
cycle.
Inclusion Criteria:
1. Signed informed consent provided prior to any study-related procedure being performed;
2. Able to swallow and retain orally administered medication;
3. Male aged 18 years and older (adult, older adult) at the time consent is obtained;
4. Histologically or cytologically confirmed diagnosis of prostate carcinoma;
5. Men with either non-metastatic or metastatic CRPC are eligible;
6. Completed at least 4 or more weeks of prior continuous therapy with fixed stable dose
enzalutamide, abiraterone or apalutamide prior to initiating study treatment (for Part
1), or with fixed stable dose enzalutamide (for Part 2), with no change in dose for at
least 2 weeks prior to screening;
7. Serum testosterone level <50 ng/dL (<0.5 ng/mL, <7.0 nmol/L). Subjects may have
ongoing androgen deprivation therapy (ADT) with a luteinizing hormone-releasing
hormone (LHRH) "super-agonist" or antagonist, and/or be surgically or medically
castrated;
8. ECOG performance status of 0 or 1;
9. Adequate baseline organ function;
10. Must have a QT interval corrected for heart rate according to Fridericia's formula
(QTcF) <470 milliseconds (msec) or <480 msec with bundle branch block;
11. Male subject with a female partner of childbearing potential must have either had a
prior vasectomy or agree to use effective contraception from time of screening until 3
months after the last dose of study medication;
12. Willing and able to comply with all protocol required visits and assessments.
Exclusion Criteria:
1. Life expectancy less than 3 months;
2. Discontinuation of bicalutamide or nilutamide in less than 6 weeks, and other
antiandrogens in less than 4 weeks, prior to the start of study medication;
3. Prior chemotherapy, radiation (limited radiotherapy to control bone pain is
permitted), sipuleucel-T or other experimental immunotherapy less than 4 weeks prior
to the start of study medication;
4. Prior malignancy other than CRPC. Subjects who have been disease-free for 5 years, or
subjects with a history of completely resected non-melanoma skin cancer or
successfully treated in situ carcinoma are eligible;
5. Screening blood counts with:
1. absolute neutrophil count <1500/μL
2. platelets <100,000/μL
3. hemoglobin <9 g/dL;
6. Screening chemistry test results with:
1. alanine aminotransferase (ALT) and aspartate transaminase (AST) >2.5 × ULN
2. total bilirubin >2 × ULN
3. for the dose escalation cohort, creatinine clearance of <70 mL/min as determined
by Cockcroft and Gault formula
4. for the dose expansion cohort, subjects with creatinine clearance of <50 mL/min
will be excluded (if kidneys are not working properly, there is a risk that
KPG-121 may stay in the blood circulation longer than expected and may increase
side-effects)
5. albumin <2.8 g/dL;
7. Uncontrolled hypothyroidism, or TSH >2.0 x ULN at screening. Subjects who are
clinically euthyroid and on stable thyroid replacement therapy for 2 months prior to
enrollment are allowed;
8. Current use of or anticipated requirement during the study of prohibited
medication(s), any investigational drug, other anti-cancer therapy (chemotherapy,
radiation therapy, immunotherapy, biologic therapy, or hormone therapy other than for
replacement), AR antagonists (e.g., bicalutamide, flutamide, nilutamide), 5-alpha
reductase inhibitors (e.g., finasteride, dutasteride), androgens (e.g., testosterone,
dihydroepiandrosterone), Herbal medication(s) that may affect PSA levels (e.g., saw
palmetto), Other herbal medications including, but not limited to: St. John's wort,
kava, ephedra (ma huang), gingko biloba, yohimbe and ginseng);
9. Any unresolved ≥grade 2 (per CTCAE v5.0) toxicity from previous anti-cancer therapy at
the time of enrollment, except for grade 2 alopecia, anemia (if hemoglobin is >9.0
g/dL) or neuropathy;
10. Any ≥grade 2 hypophosphatemia (per CTCAE v5.0) at the time of enrollment;
11. Serum calcium ≥grade 1 (per CTCAE v5.0) at time of enrollment, unless ionized calcium
is within normal range;
12. Presence of any clinically significant gastrointestinal (GI) abnormality or other
condition(s) that may alter absorption such as malabsorption syndrome or major
resection of the stomach or substantial portion of the small intestine;
13. Active peptic ulcer disease or history of abdominal fistula, GI perforation, or intra
abdominal abscess within 28 days prior to enrollment;
14. Previous history of difficulty swallowing capsules;
15. Known active infection requiring intravenous (IV) or oral anti-infective treatment or
serious persistent infection within 14 days prior to the start of study medication;
16. Presence of hepatitis B surface antigen (HBsAg), positive hepatitis C antibody test
result at screening or within 3 months prior to the start of study medication;
17. Evidence of severe or uncontrolled systemic diseases (e.g., unstable or uncompensated
respiratory, hepatic, renal or cardiac disease);
18. History of seizure or any condition that may predispose subject to seizure (e.g.,
prior cortical stroke or significant brain trauma). History of loss of consciousness
or transient ischemic attack within 12 months prior to the start of study medication;
19. Poorly controlled hypertension (defined as systolic BP ≥150 mmHg) or diastolic BP >100
mmHg based on a mean of three measurements at approximately 2-minute intervals);
20. Have a known immediate or delayed hypersensitivity reaction or idiosyncrasy to drugs
chemically related to enzalutamide or abiraterone or apalutamide or excipients.
Allergy to acetaminophen or NSAIDs;
21. History of impaired adrenal gland function (e.g., Addison's disease, Cushing's
syndrome);
22. History or evidence of cardiovascular risk including any of the following: Clinically
significant ECG abnormalities including second degree (Type II) or third degree
atrioventricular block; history of myocardial infarction, acute coronary syndromes
(including unstable angina), coronary angioplasty, stenting, or bypass grafting within
6 months prior to enrollment, Class III or IV heart failure as defined by the New York
Heart Association functional classification system, left ventricular ejection fraction
(LVEF) below 45% at screening; known cardiac metastases;
23. Anticoagulants used by subjects with a history of thromboembolic conditions within 6
months prior to enrollment. Note: Subjects receiving anticoagulants for atrial
fibrillation are eligible for the study;
24. Use of systemic glucocorticoid (e.g., prednisone, dexamethasone) within 14 days prior
to the start of study medication;
25. Serious concurrent medical condition including central nervous system disorders;
26. Previous major surgery within 30 days prior to the start of study medication;
27. Blood transfusion (including blood products) within 1 week of screening;
28. Any condition that, in the opinion of the investigator, would impair the subject's
ability to comply with study procedures.