Inclusion Criteria:
- Patients with histologically or cytologically confirmed advanced or metastatic solid
tumors of any histologic classification at the time of diagnosis
- Written documentation of local or central Clinical Laboratory Improvement Act
(CLIA)-certified laboratory determination of FGFR gene fusions/translocations or
activating mutations
- The study is open to solid tumors in the following cohorts:
- Cohort 1: Solid tumor patients with FGFR1-3 fusion/translocation (n=10) who have
progressed on or are intolerant to standard of care (SOC) therapies and received
treatment with a different FGFR inhibitor. Cholangiocarcinoma patients are
permitted in this cohort
- Cohort 2: Solid tumor patients with FGFR1-3 fusion/translocation (n, up to 30)
who have progressed on or are intolerant to SOC therapies. Prior therapy with a
different FGFR inhibitor is not permitted. Cholangiocarcinoma patients are
excluded from this cohort (there are multiple competing studies and opportunities
for patients to get treatment in other trials)
- Cohort 3: Solid tumor patients with genetic alterations such as point mutations,
insertions/deletions, or amplifications in any FGFR gene family member (n=10).
Prior therapy with a different FGFR inhibitor is not permitted.
Cholangiocarcinoma patients are permitted in this cohort
- Evidence of measurable or evaluable disease according to Response Evaluation Criteria
in Solid Tumors (RECIST) version 1.1
- Patients must have received at least one prior SOC regimen for advanced/metastatic
cancer. Patient should have had evidence of progressive disease following their prior
regimen, or if prior treatment was discontinued due to toxicity must have continued
evidence of measurable or evaluable disease. Patients who have received prior
treatment with an alternate FGFR inhibitor are still eligible for the study
- Patients with primary central nervous system (CNS) cancer or CNS metastases are
excluded (because it is unclear how much CNS penetration the drug has). However,
asymptomatic patients with history of successfully treated CNS metastases with surgery
or radiation and follow up imaging showing stability, can be eligible
- Eastern Cooperative Oncology Group (ECOG) performance status =< 1 (patients with ECOG
performance status of 2 may be considered on a case-by-case basis after discussion
with QED Therapeutics)
- Able to read and/or understand the details of the study and provide written evidence
of informed consent as approved by Institutional Review Board (IRB)/Ethics Committee
(EC)
- Recovery from adverse events of previous systemic anti-cancer therapies to baseline or
grade 1, except for:
- Alopecia
- Stable neuropathy of =< grade 2 due to prior cancer therapy
- Able to swallow and retain oral medication
- Willing and able to comply with scheduled visits, treatment plan and laboratory tests
Exclusion Criteria:
- Patients who have therapies available that are known to confer a clinical benefit will
be excluded from the study
- Neurological symptoms related to underlying disease requiring increasing doses of
corticosteroids. Note: Steroid use for management of CNS tumors is allowed but must be
at a stable dose for at least 2 weeks preceding study entry
- History of another primary malignancy except adequately treated in situ carcinoma of
the cervix or non-melanoma carcinoma of the skin or any other curatively treated
malignancy that is not expected to require treatment for recurrence during the course
of the study or affect survival
- Any other medical condition that would, in the investigator's judgment, prevent the
patient's participation in the clinical study due to safety concerns or compliance
with clinical study procedures
- Current evidence of corneal or retinal disorder/keratopathy including, but not limited
to, bullous/band keratopathy, corneal abrasion, inflammation/ulceration,
keratoconjunctivitis, confirmed by ophthalmologic examination
- History and/or current evidence of extensive tissue calcification including, but not
limited to, the soft tissue, kidneys, intestine, myocardium and lung with the
exception of calcified lymph nodes, minor pulmonary parenchymal calcifications, and
asymptomatic coronary calcification
- Impairment of gastrointestinal (GI) function or GI disease that may significantly
alter the absorption of oral infigratinib (e.g., ulcerative diseases, uncontrolled
nausea, vomiting, diarrhea, malabsorption syndrome, small bowel resection)
- Current evidence of endocrine alterations of calcium/phosphate homeostasis, e.g.,
parathyroid disorders, history of parathyroidectomy, tumor lysis, tumoral calcinosis
etc
- Treatment with any of the following anti-cancer therapies prior to the first dose of
infigratinib within the stated timeframes:
- Cyclical chemotherapy (intravenous) within a period of time that is shorter than
the cycle length used for that treatment (e.g., 6 weeks for nitrosourea,
mitomycin-C)
- Biological therapy (e.g., antibodies - including bevacizumab) within a period of
time that is =< 5 half-life (t1/2) or =< 4 weeks, whichever is shorter, prior to
starting study drug
- Continuous or intermittent small molecule therapeutics within a period of time
that is =< 5 t1/2 or =< 4 weeks (whichever is shorter) prior to starting study
drug
- Any other investigational agents within a period of time that is =< 5 t1/2 or
less than the cycle length used for that treatment or =< 4 weeks (whichever is
shortest) prior to starting study drug
- Wide field radiotherapy (including therapeutic radioisotopes such as strontium
89) =< 4 weeks or limited field radiation for palliation =< 2 weeks prior to
starting study drug
- Patients who are currently receiving treatment with agents that are known strong
inducers or inhibitors of CYP3A4 and medications which increase serum phosphorus
and/or calcium concentration are excluded. Patients are not permitted to receive
enzyme-inducing anti-epileptic drugs
- Consumption of grapefruit, grapefruit juice, grapefruit hybrids, pomegranates, star
fruits, pomelos, Seville oranges or products within 7 days prior to first dose
- Use of medications that are known to prolong the QT interval and/or are associated
with a risk of Torsades de Pointes (TdP) 7 days prior to first dose
- Use of amiodarone within 90 days prior to first dose
- Current use of therapeutic doses of warfarin sodium or any other coumadin-derivative
anticoagulants. Heparin and/or low molecular weight heparins are allowed
- Absolute neutrophil count (ANC) =< 1,000/mm^3 (1.0 x 10^9/L)
- Platelets =< 75,000/mm^3 (75 x 10^9/L)
- Hemoglobin =< 9.0 g/dL
- Total bilirubin >= 1.5 x upper limit of normal (ULN) unless associated with patient's
primary cancer and/or metastases and with principal investigator's approval
- Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) >= 3 x ULN unless
associated with patient's primary cancer and/or metastases and with principal
investigator's approval
- Alkaline phosphatase >= 2.5 x ULN unless associated with patient's primary cancer
and/or metastases and with principal investigator's approval
- Calculated or measured creatinine clearance of < 40 mL/min
- Calcium-phosphate homeostasis:
- Inorganic phosphorus outside of institutional normal limits
- Total serum calcium (can be corrected) outside of institutional normal limits
- Clinically significant cardiac disease including any of the following:
- Congestive heart failure requiring treatment (New York Heart Association [NYHA]
grade >= 2), left ventricular ejection fraction (LVEF) < 50% as determined by
multi-gated acquisition (MUGA) scan or echocardiogram (ECHO), or uncontrolled
hypertension (refer to World Health Organization [WHO] and International Society
for Hypertension [ISH] guidelines)
- History or presence of clinically significant ventricular arrhythmias, atrial
fibrillation, resting bradycardia, or conduction abnormality
- Unstable angina pectoris or acute myocardial infarction =< 3 months prior to
starting study drug
- Corrected QT using Fridericia's formula (QTcF) > 470 msec (males and females)
- History of congenital long QT syndrome
- Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a
female after conception and until the termination of gestation, confirmed by a
positive human chorionic gonadotropin (hCG) laboratory test
- Women of child-bearing potential (WOCBP), defined as all women physiologically capable
of becoming pregnant, unless they are using highly effective methods of contraception
during dosing and for 3 months following the discontinuation of study treatment.
Highly effective contraception methods include:
- Total abstinence (when this is in line with the preferred and usual lifestyle of
the patient. Periodic abstinence (e.g., calendar, ovulation, symptothermal,
post-ovulation methods) and withdrawal are not acceptable methods of
contraception
- Female sterilization (have had surgical bilateral oophorectomy with or without
hysterectomy) or tubal ligation at least six weeks before taking study treatment.
In case of oophorectomy alone, only when the reproductive status of the woman has
been confirmed by follow-up hormone level assessment
- Male sterilization (at least 6 months prior to screening). For female patients on
the study the vasectomized male partner should be the sole partner for that
patient
- Use of oral, injected or implanted hormonal methods of contraception or placement
of an intrauterine device (IUD) or intrauterine systems (IUS), or other forms of
hormonal contraception that have comparable efficacy (failure rate < 1%), for
example hormone vaginal ring or transdermal hormone contraception
- In case of use of oral contraception women should have been stable on the same
pill for a minimum of 3 months before taking study treatment. Women are
considered post-menopausal and not of child bearing potential if they have had 12
months of natural (spontaneous) amenorrhea with an appropriate clinical profile
(e.g. age appropriate, history of vasomotor symptoms) or have had surgical
bilateral oophorectomy (with or without hysterectomy) or tubal ligation at least
6 weeks ago. In the case of oophorectomy alone, only when the reproductive status
of the woman has been confirmed by follow-up hormone level assessment is she
considered not of child bearing potential
- Sexually active males unless they use a condom during intercourse while taking drug
and for 3 months after the last dose of the study drug and should not father a child
in this period. A condom is required to be used also by vasectomized men as well as
during intercourse with a male partner in order to prevent delivery of the drug via
seminal fluid
