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Dose-escalation Study of Oral Administration of LP-108 in Patients With Relapsed or Refractory Myelodysplastic Syndromes (MDS), Chronic Myelomonocytic Leukemia (CMML), or Acute Myeloid Leukemia (AML)

NCT04139434

Description:

A Phase 1, Multi-center, Open-label, Dose Escalation Study to Evaluate Safety, Tolerability, Pharmacokinetics, and Clinical Activity of Orally Administered LP-108 in Subjects with Relapsed or Refractory Myelodysplastic Syndromes (MDS), Chronic Myelomonocytic Leukemia (CMML), or Acute Myeloid Leukemia (AML)

Related Conditions:
  • Acute Myeloid Leukemia
  • Chronic Myelomonocytic Leukemia
  • Myelodysplastic Syndromes
  • Refractory Anemia with Excess Blasts
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Dose-escalation Study of Oral Administration of LP-108 in Patients With Relapsed or Refractory Myelodysplastic Syndromes (MDS), Chronic Myelomonocytic Leukemia (CMML), or Acute Myeloid Leukemia (AML)
  • Official Title: A Phase 1, Multicenter, Open-label, Dose-escalation Study to Evaluate Safety, Tolerability, Pharmacokinetics, and Clinical Activity of Orally Administered LP-108 in Subjects With Relapsed or Refractory Myelodysplastic Syndromes (MDS), Chronic Myelomonocytic Leukemia (CMML), or Acute Myeloid Leukemia (AML)

Clinical Trial IDs

  • ORG STUDY ID: LP-108P
  • NCT ID: NCT04139434

Conditions

  • AML/MDS
  • CMML
  • Relapse
  • Refractory Acute Lymphoblastic Leukemia
  • Relapse Leukemia
  • Relapsed Adult AML

Interventions

DrugSynonymsArms
LP-108Dose Escalation Phase
LP-108Dose Expansion Phase

Purpose

A Phase 1, Multi-center, Open-label, Dose Escalation Study to Evaluate Safety, Tolerability, Pharmacokinetics, and Clinical Activity of Orally Administered LP-108 in Subjects with Relapsed or Refractory Myelodysplastic Syndromes (MDS), Chronic Myelomonocytic Leukemia (CMML), or Acute Myeloid Leukemia (AML)

Detailed Description

      The primary objectives are to assess the safety and tolerability profile, determine the
      maximum tolerated dose (MTD), and/or the recommended Phase 2 dose (RP2D) of LP-108
      administered daily as a single agent dosed orally in adult subjects with relapsed/refractory
      MDS/CMML/AML; to characterize the pharmacokinetics (PK) profile of LP-108 in adult subjects
      with relapsed/refractory MDS/CMML/AML.

      Secondary objectives are to evaluate preliminary efficacy regarding the effect of LP-108
      (monotherapy or combination therapy) on ORR for AML, MDS, CMML, PFS, DOR, and OS
    

Trial Arms

NameTypeDescriptionInterventions
Dose Escalation PhaseExperimentalThree to 6 subjects per treatment cohort will be assigned to receive sequentially higher oral doses of LP-108 on a once daily schedule for 28 days (a "Cycle" starting at a dose of 100 mg.
  • LP-108
Dose Expansion PhaseExperimentalAdditional subjects will be recruited to further explore the safety, tolerability, PK, and efficacy in specific subject subgroups. One or more RP2D may be explored.
  • LP-108

Eligibility Criteria

        Inclusion Criteria:

        A subject will be eligible for study participation if the subject meets the following
        criteria:

          -  Eligible subject must have an advanced hematologic malignancy including:

               -  MDS with refractory anemia with excess blasts (RAEB; subtype RAEB-1 or RAEB-2) as
                  defined by World Health Organization (WHO) 2016 revised criteria and/or MDS with
                  high- or very high-risk (risk score > 4.5) per the Revised International
                  Prognostic Scoring System (IPSS-R) (Greenberg et al. 2012) that is relapsed or
                  refractory to prior therapy for MDS, or the subject is intolerant to established
                  therapy known to provide clinical benefit for their condition (ie, subjects must
                  not be candidates for regimens known to provide clinical benefit), according to
                  the treating physician and with approval of the Medical Monitor;

               -  Relapsed and/or primary refractory AML as defined by WHO 2016 revised criteria;

               -  CMML (with ≥ 5% blasts in bone marrow) as defined by WHO 2016 revised criteria
                  that is relapsed and/or refractory and that, in the opinion of the Investigator,
                  requires treatment or that has exhausted treatment options that would be
                  considered standard of care.

          -  Blast count ≤ 30 × 10^9 cells/L at the time of initiating investigational therapy
             (hydroxyurea is allowed to control blast count prior to and during therapy).

          -  Subject must have adequate coagulation, renal, and hepatic function.

               -  Activated partial thromboplastin time and prothrombin time not to exceed 1.5 ×
                  the upper limit of normal (ULN);

               -  Calculated creatinine clearance (Cr Cl) ≥ 60 mL/min using 24-hour CrCl OR
                  Cockcroft-Gault formula (using actual body weight)

               -  Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 3.0 ×ULN;
                  bilirubin ≤ 1.5 × ULN (except subjects with Gilbert's Syndrome, who may have a
                  bilirubin > 1.5 × ULN, per discussion between the Investigator and the Medical
                  Monitor).

          -  Adequate cardiac function defined as: shortening fraction of ≥ 27% by echocardiogram,
             or ejection fraction of ≥ 50% by echocardiogram.

        Exclusion Criteria:

        A subject will not be eligible for study participation if he/she meets any of the following
        criteria.

          -  Subjects with a diagnosis of promyelocytic leukemia/retinoic acid receptor alpha
             (PML-RARA) or non-PML-RARA rearranged acute promyelocytic leukemia (APL).

          -  Subjects who have undergone hematopoietic stem cell transplantation (HSCT) within 60
             days of the first dose of LP-108, or subjects on immunosuppressive therapy post-HSCT
             at the time of Screening, or with clinically significant graft-versus-host disease
             (GVHD). (Subjects in relapse after allogeneic transplantation must be off calcineurin
             inhibitors for at least 4 weeks. The use of topical steroids and/or up to 20 mg/day
             prednisone or equivalent systemic steroids for ongoing GVHD is permitted).

          -  Subject has received any of the following therapies within 14 days or 5 half-lives
             (whichever is shorter) prior to the first dose of study drug, or has not recovered to
             ≤ Grade 1 clinically significant adverse effect(s) of the previous therapy:

               -  Any anti-cancer therapy including chemotherapy, hormonal therapy, biologic or
                  immunotherapy, targeted small molecule agents, etc. (corticosteroid therapy < 20
                  mg/day prednisone equivalent for < 14 days at time of study treatment and
                  hydroxyurea cytoreduction therapy according to institutional guidelines to treat
                  disease associated symptoms are permitted).

               -  Any investigational therapy.

          -  Subject has received the following medications or therapies within 7 days or 5
             half-lives (whichever is shorter) prior to the first dose of study drug:

               -  Cytochrome P450, family 3, subfamily A (CYP3A4) strong inhibitors (see Appendix
                  10 for strong CYP3A4 inhibitors). In Phase 1b of this trial, the criterion
                  regarding CYP3A4 strong inhibitors will be removed at time of amendment of the
                  trial when Phase 1b is to be initiated. The amendment will include
                  recommendations on concomitant dosing of LP-108 and strong CYP3A4 inhibitors such
                  as azole antifungal agents, PK monitoring for the initial weeks on study, as well
                  as closer safety monitoring for subjects.

               -  Strong CYP3A4 inducers such as rifampin, carbamazepine, phenytoin, and St. John's
                  wort.

               -  Inhibitors of P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP)
                  (see Appendix 11 for P gp and BCRP inhibitors).

          -  Subject has baseline prolongation of the corrected QTc > 480 ms (calculated per
             Fridericia's formula [QTc = QT/RR (1/3)].

          -  Subject has a history of other malignancies other than the eligible hematologic
             malignancy within the past 1 year prior to study entry, with the exception of:

               -  Subject with breast cancer or prostrate cancer on endocrine therapy with stable
                  disease.

               -  Adequately treated in situ carcinoma of the cervix uteri;

               -  Basal cell carcinoma of the skin or localized squamous cell carcinoma of the
                  skin;

               -  Previous malignancy confined and surgically resected (or treated with other

          -  Subject exhibits evidence of other clinically significant uncontrolled condition(s)
             including, but not limited to:

               -  Uncontrolled systemic infection (bacterial, fungal, viral)

               -  Known active or poorly controlled human immunodeficiency virus or active
                  hepatitis B or C infection

               -  Unexplained fever > 38.5 °C during the Screening period or on their first day of
                  study drug administration (at the discretion of the Investigator, if the fever is
                  considered related to the subject's malignancy may be enrolled).

          -  Subjects with known and active central nervous system (CNS) involvement (radiographic
             or cytologic) at Screening; subjects with history of CNS involvement who have no
             symptoms suggestive of CNS disease and have had at least 2 successful lumbar punctures
             without cytologic evidence of leukemia may be included after discussion and approval
             of the Medical Monitor. (Evaluation of cerebrospinal fluid is only required if there
             is a clinical suspicion of CNS involvement by leukemia during screening in subjects
             without a history of CNS involvement).

          -  Subjects with immediate life-threatening, severe complications of leukemia such as
             uncontrolled bleeding, pneumonia with hypoxia or shock, and/or disseminated
             intravascular coagulation.

          -  Requires ongoing treatment with

               -  Systemic acid-reducing agents including H-2-receptor antagonists and proton pump
                  inhibitors

               -  Sensitive CYP2C8 substrates (such as montelukast, pioglitazone, repaglinide,
                  rosiglitazone) or CYP2C8 substrates with a narrow therapeutic index (eg,
                  amiodarone, fosphenytoin, paclitaxel, penprocoumon, phenytoin)
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Maximum Tolerated Dose (MTD)
Time Frame:up to 13 cycles (one cycle has 4 weeks)
Safety Issue:
Description:

Secondary Outcome Measures

Measure:Objective Response Rate (ORR) for AML
Time Frame:up to 13 cycles (one cycle has 4 weeks)
Safety Issue:
Description:Assessment will be based on revised recommendations of the ELN 2017.
Measure:ORR for MDS
Time Frame:up to 13 cycles (one cycle has 4 weeks)
Safety Issue:
Description:Assessment will be based on the proposed International Working Group 2006 criteria for MDS patients.
Measure:ORR for CMML
Time Frame:up to 13 cycles (one cycle has 4 weeks)
Safety Issue:
Description:Assessment will be based on international consortium proposal of uniform response criteria for myelodysplastic/myeloproliferative neoplasms (MDS/MPN) for CMML patients.
Measure:Progression-Free Survival (PFS)
Time Frame:up to 13 cycles (one cycle has 4 weeks)
Safety Issue:
Description:PFS is defined as the time from start of treatment until objective disease progression or death, whichever occurs first.
Measure:Duration of Response (DOR)
Time Frame:up to 13 cycles (one cycle has 4 weeks)
Safety Issue:
Description:DOR is for all subjects achieving an objective response.
Measure:Event-Free Survival (EFS)
Time Frame:up to 13 cycles (one cycle has 4 weeks)
Safety Issue:
Description:EFS is defined as the time from the start of LP-108 therapy until the earliest date of refractory disease or relapse.
Measure:Overall Survival (OS)
Time Frame:up to 13 cycles (one cycle has 4 weeks)
Safety Issue:
Description:Overall survival is defined as the time from treatment initiation until death from any cause.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Newave Pharmaceutical Inc

Trial Keywords

  • AML
  • MDS
  • CMML
  • relapse
  • refractory
  • LP-108

Last Updated

June 30, 2021