Description:
Phase 1 will evaluate the safety and tolerability at different dose levels of repotrectinib
in pediatric and young adult subjects with advanced or metastatic malignancies harboring
anaplastic lymphoma kinase (ALK), receptor tyrosine kinase encoded by the gene ROS1 (ROS1),
or neurotrophic receptor kinase genes encoding TRK kinase family (NTRK1-3) alterations to
estimate the Maximum Tolerated Dose (MTD) or Maximum Administered Dose (MAD) and select the
Pediatric Recommended Phase 2 Dose (RP2D).
Phase 2 will determine the anti-tumor activity of repotrectinib in pediatric subjects with
advanced or metastatic malignancies harboring ALK, ROS1, or NTRK1-3 alterations.
Title
- Brief Title: A Study of Repotrectinib in Pediatric and Young Adult Subjects Harboring ALK, ROS1, OR NTRK1-3 Alterations
- Official Title: A Phase 1/2, Open-Label, Safety, Tolerability, Pharmacokinetics, and Anti-Tumor Activity Study of Repotrectinib in Pediatric and Young Adult Subjects With Advanced or Metastatic Malignancies Harboring ALK, ROS1, NTRK1-3 Alterations
Clinical Trial IDs
- ORG STUDY ID:
TPX-0005-07
- NCT ID:
NCT04094610
Conditions
- Locally Advanced Solid Tumors
- Metastatic Solid Tumors
- Lymphoma
- Primary CNS Tumors
Interventions
Drug | Synonyms | Arms |
---|
Oral repotrectinib (TPX-0005) | Oral repotrectinib (TPX-0005) capsules, Oral repotrectinib (TPX-0005) oral suspension, repotrectinib | Repotrectinib (TPX-0005) |
Purpose
Phase 1 will evaluate the safety and tolerability at different dose levels of repotrectinib
in pediatric and young adult subjects with advanced or metastatic malignancies harboring
anaplastic lymphoma kinase (ALK), receptor tyrosine kinase encoded by the gene ROS1 (ROS1),
or neurotrophic receptor kinase genes encoding TRK kinase family (NTRK1-3) alterations to
estimate the Maximum Tolerated Dose (MTD) or Maximum Administered Dose (MAD) and select the
Pediatric Recommended Phase 2 Dose (RP2D).
Phase 2 will determine the anti-tumor activity of repotrectinib in pediatric subjects with
advanced or metastatic malignancies harboring ALK, ROS1, or NTRK1-3 alterations.
Detailed Description
Enrollment of subjects into Phase 1 will proceed concurrently by age as follows:
- Subjects <12 years old will initially be enrolled in the Phase 1 part to determine the
pediatric RP2D for this age group; once the pediatric RP2D is determined, subjects age
<12 years old may be enrolled into the Phase 2 part of the study.
- Subjects 12 to 25 years old will be directly enrolled into the Phase 2 part concurrent
with Phase 1 enrollment.
Phase 1:
Approximately 12 pediatric subjects with locally advanced or metastatic solid tumors,
including a primary central nervous system (CNS) tumor, or anaplastic large cell lymphoma
(ALCL), with disease progression or who are non-responsive or intolerant to available
therapies and for which no standard or available curative therapy exists.
Phase 2:
Subjects will be enrolled in one of 3 cohorts as follows:
Cohort 1: approximately 10-20 subjects with solid tumors characterized by NTRK fusion, TRK
tyrosine kinase inhibitor (TKI)-naïve, and centrally confirmed measurable disease at
baseline.
Cohort 2: approximately 23 subjects with solid tumors characterized by NTRK fusion, TRK
TKI-pretreated, and centrally confirmed measurable disease at baseline.
Cohort 3: approximately 20 subjects with solid tumors or ALCL characterized by other
ALK/ROS1/NTRK alterations or NTRK fusions without centrally confirmed measurable disease not
otherwise eligible for Cohort 1 or 2.
Trial Arms
Name | Type | Description | Interventions |
---|
Repotrectinib (TPX-0005) | Experimental | Phase 1
Oral repotrectinib (TPX-0005):
Safety and tolerability at different dose levels
Phase 2
Oral repotrectinib (TPX-0005): 3 cohorts
Cohort 1: TKI-naive NTRK fusion Cohort 2: Prior TKI NTRK fusion Cohort 3: ALK/ROS1/NTRK alterations or fusions in tumors and ALCL | - Oral repotrectinib (TPX-0005)
|
Eligibility Criteria
Key Inclusion Criteria:
1. Documented genetic ALK, ROS1, or NTRK1-3 alteration (point mutation, fusion,
amplification) as identified by local testing in a Clinical Laboratory Improvement
Amendments (CLIA) laboratory in the US or equivalently accredited diagnostic lab
outside the United States (US) is required.
2. Age <12 years.
3. Prior cytotoxic chemotherapy is allowed.
4. Prior immunotherapy is allowed.
5. Resolution of all acute toxic effects (excluding alopecia) of any prior anti-cancer
therapy to National Cancer Institute Common Terminology Criteria for Adverse Events
(NCI CTCAE) Version 4.03 Grade less than or equal to 1.
6. All subjects must have measurable disease by RECIST v1.1 or Response Assessment in
Neuro-Oncology Criteria (RANO) criteria at time of enrollment.
7. Subjects with a primary CNS tumor or CNS metastases must be neurologically stable on a
stable or decreasing dose of steroids for at least 14 days prior to enrollment.
8. Subjects must have a Lansky (< 16 years) or Karnofsky (≥ 16 years) score of at least
50.
9. Life expectancy greater than or equal to 12 weeks.
10. Adequate hematologic, renal and hepatic function.
Phase 2 Inclusion Criteria:
1. Age 12 to <25 years
2. Cohort Specific Inclusion Criteria:
- Cohort 1: Subjects with NTRK fusion gene positive (NTRK+) advanced solid tumors
(including primary CNS tumors), that are tropomyosin receptor kinase (TRK) TKI
naïve;
- Cohort 2: subjects with NTRK+ advanced solid tumors (including primary CNS
tumors), that are TRK TKI pre-treated;
- Cohort 3: subjects with tumors or ALCL characterized by other ALK/ROS1/NTRK
alterations or NTRK fusions without centrally confirmed measurable disease or not
otherwise eligible for Cohort 1 or 2.
3. Subjects in Cohorts 1 and 2 must have prospectively confirmed measurable disease by
BICR prior to enrollment.
Key Exclusion Criteria (Phase 1 and Phase 2):
1. Subjects with neuroblastoma with only bone marrow disease evaluable by bone marrow
aspiration only.
2. Major surgery within 14 days (2 weeks) of start of repotrectinib treatment. Central
venous access (Broviac, Mediport, etc.) placement does not meet criteria for major
surgery.
3. Known active infections (bacterial, fungal, viral including HIV positivity).
4. Gastrointestinal disease (e.g., Crohn's disease, ulcerative colitis, or short gut
syndrome) or other malabsorption syndromes that would impact drug absorption.
5. Any of the following cardiac criteria:
- Mean resting corrected QT interval (ECG interval measured from the onset of the
QRS complex to the end of the T wave) for heart rate (QTc) > 470 msec obtained
from three ECGs, using the screening clinic ECG machine-derived QTc value
- Any clinically important abnormalities in rhythm, conduction, or morphology of
resting ECG (e.g., complete left bundle branch block, third degree heart block,
second degree heart block, PR interval > 250 msec)
- Any factors that increase the risk of QTc prolongation or risk of arrhythmic
events such as heart failure, congenital long QT syndrome, family history of long
QT syndrome, or any concomitant medication known to prolong the QT interval
6. Peripheral neuropathy of CTCAE ≥grade 2.
7. Subjects being treated with or anticipating the need for treatment with strong CYP3A4
inhibitors or inducers.
Maximum Eligible Age: | 25 Years |
Minimum Eligible Age: | N/A |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Dose limiting toxicities (DLTs) (Phase 1) |
Time Frame: | Within 28 days of the first repotrectinib dose |
Safety Issue: | |
Description: | Define the dose limiting toxicities (DLTs) (Phase 1) |
Secondary Outcome Measures
Measure: | Overall Response Rate (ORR) (Phase 1) |
Time Frame: | Approximately three years |
Safety Issue: | |
Description: | To determine the overall response rate (ORR) by Blinded Independent Central Review (BICR) (Phase 1) |
Measure: | Clinical Benefit Rate (CBR) (Phase 1 and Phase 2) |
Time Frame: | Approximately three years |
Safety Issue: | |
Description: | To determine the CBR of repotrectinib (TPX-0005) (Phase 1 and Phase 2) |
Measure: | Time to response (TTR) (Phase 1 and Phase 2) |
Time Frame: | Approximately three years |
Safety Issue: | |
Description: | To determine the TTR of reprotrectinib (TPX-005) (Phase 1 and Phase 2) |
Measure: | Duration of response (DOR) (Phase 1 and Phase 2) |
Time Frame: | Approximately three years |
Safety Issue: | |
Description: | To determine the DOR of repotrectinib (TPX-0005) (Phase 1 and Phase 2) |
Measure: | Intracranial objective response rate (IC-ORR) (Phase 1 and Phase 2) |
Time Frame: | Approximately three years |
Safety Issue: | |
Description: | To determine the IC-ORR of repotrectinib (TPX-005) (Phase 1 and Phase 2) |
Measure: | Central Nervous System Progression-Free Survival (CNS-PFS) (Phase 2) |
Time Frame: | Approximately three years |
Safety Issue: | |
Description: | CNS-PFS in subjects with measurable brain metastases (Phase 2) |
Measure: | Progression-free survival (PFS) (Phase 2) |
Time Frame: | Approximately three years |
Safety Issue: | |
Description: | To determine the PFS (Phase 2) |
Measure: | Overall survival (OS) (Phase 2) |
Time Frame: | Approximately three years |
Safety Issue: | |
Description: | To determine the OS (Phase 2) |
Measure: | Maximum concentration of repotrectinib in plasma (Cmax) |
Time Frame: | Pre-dose and up to 24 hours post-dose on Day 1 and Day 15 in Cycle 1 (each cycle is 28 days) |
Safety Issue: | |
Description: | To determine the Cmax |
Measure: | Area under the concentration versus time curve of repotrectinib in plasma (AUC) |
Time Frame: | Pre-dose and up to 24 hours post-dose on Day 1 and Day 15 in Cycle 1 (each cycle is 28 days) |
Safety Issue: | |
Description: | To determine the AUC |
Details
Phase: | Phase 1/Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Turning Point Therapeutics, Inc. |
Trial Keywords
- ALK
- ROS1
- NTRK1-3
- Primary CNS tumor
- anaplastic large cell lymphoma
- metastatic solid tumor
- advanced solid tumor
- sarcoma
- infantile fibrosarcoma
- glioblastoma
- soft tissue schwannoma
- solitary fibrous tumor
- glioma
- inflammatory myofibroblastic tumor
- pediatric
Last Updated
January 20, 2021