Clinical Trials /

Infigratinib for the Treatment of Advanced or Metastatic Solid Tumors in Patients With FGFR Gene Mutations

NCT04233567

Description:

This phase II trial studies how well infigratinib works in treating solid tumors that have spread to other places in the body (advanced or metastatic) in patients with FGFR gene mutations such as FGFR1-3 gene fusions or other FGFR genetic alterations. Mutations are any changes in the genetic material (DNA) of a cell. FGFR proteins are involved in cell division, cell maturation, formation of new blood vessels, wound healing, and bone growth, development, and maintenance. FGFR mutations can cause the FGFR protein to become over-active in diseases such as cancer. Infigratinib may stop the growth of tumor cells by blocking FGFR proteins in these tumors.

Related Conditions:
  • Cholangiocarcinoma
  • Malignant Solid Tumor
Recruiting Status:

Not yet recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Infigratinib for the Treatment of Advanced or Metastatic Solid Tumors in Patients With FGFR Gene Mutations
  • Official Title: A Phase II Study of Oral Infigratinib in Adult Patients With Advanced or Metastatic Solid Tumors With FGFR1-3 Gene Fusions or Other FGFR Genetic Alterations

Clinical Trial IDs

  • ORG STUDY ID: OSU-19041
  • SECONDARY ID: NCI-2019-06869
  • SECONDARY ID: OSU-19041
  • SECONDARY ID: P30CA016058
  • NCT ID: NCT04233567

Conditions

  • Advanced Malignant Solid Neoplasm
  • Cholangiocarcinoma
  • Metastatic Malignant Solid Neoplasm
  • Refractory Malignant Solid Neoplasm

Interventions

DrugSynonymsArms
Infigratinib3-(2,6-Dichloro-3,5-dimethoxyphenyl)-1-(6-((4-(4-ethylpiperazin-1-yl)phenyl)amino)pyrimidin-4-yl)-1-methylurea, BGJ-398, BGJ398Treatment (infigratinib)

Purpose

This phase II trial studies how well infigratinib works in treating solid tumors that have spread to other places in the body (advanced or metastatic) in patients with FGFR gene mutations such as FGFR1-3 gene fusions or other FGFR genetic alterations. Mutations are any changes in the genetic material (DNA) of a cell. FGFR proteins are involved in cell division, cell maturation, formation of new blood vessels, wound healing, and bone growth, development, and maintenance. FGFR mutations can cause the FGFR protein to become over-active in diseases such as cancer. Infigratinib may stop the growth of tumor cells by blocking FGFR proteins in these tumors.

Detailed Description

      PRIMARY OBJECTIVES:

      I. To evaluate the efficacy of single agent infigratinib in patients with advanced or
      metastatic solid tumors of any histologic classification with FGFR1-3 gene
      fusions/translocations or other FGFR genetic alterations (with and without prior therapy with
      different FGFR inhibitor).

      II. To understand response rate and potential for infigratinib to benefit patients who have
      FGFR alterations including point mutations, insertions/deletions and amplifications in
      different solid tumor types.

      SECONDARY OBJECTIVES:

      I. To further evaluate the efficacy of single agent infigratinib. II. To characterize the
      safety and tolerability of single agent infigratinib. II. To evaluate benefit of infigratinib
      in patients who have received one prior FGFR inhibitor.

      EXPLORATORY OBJECTIVES:

      I. To detect biomarkers of resistance to infigratinib treatment through tumor sequencing.

      II. To develop a circulating tumor deoxyribonucleic acid (DNA) (ctDNA) or liquid biopsy assay
      optimized for monitoring response to infigratinib and detecting emerging resistance mutations
      to infigratinib.

      OUTLINE:

      Patients receive infigratinib orally (PO) once daily (QD) on days 1-21. Cycles repeat every
      28 days in the absence of disease progression or unacceptable toxicity.

      Patients who complete study treatment for any reason other than disease progression are
      followed for 30 days, every 8 weeks until disease progression, and then every 4 months for 1
      year. All other patients are followed for 30 days, and then every 4 months for 1 year.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (infigratinib)ExperimentalPatients receive infigratinib PO QD on days 1-21. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
  • Infigratinib

Eligibility Criteria

        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
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Overall response rate (ORR)
Time Frame:6 cycles of treatment or upon treatment discontinuation
Safety Issue:
Description:Assessed by investigator as per Response Evaluation Criteria in Solid Tumors (RECIST) version (v)1.1. The estimated ORR will be presented along with the corresponding 90% confidence interval for each cohort, based on a binomial distribution.

Secondary Outcome Measures

Measure:Progression free survival (PFS)
Time Frame:From start of treatment to the date of the event defined as the first documented progression or death due to any cause, assessed up to 1 year post-treatment
Safety Issue:
Description:Assessed by investigator as per RECIST v1.1. Kaplan-Meier analysis of PFS will be conducted for each cohort.
Measure:Best overall response (BOR)
Time Frame:Up to 1 year post-treatment
Safety Issue:
Description:Assessed by investigator as per RECIST v1.1. BOR will be summarized for the cohorts using the ORR and the disease control rate which are the proportion of patients having respectively a best overall response of partial response (PR) or complete response (CR), or stable disease (SD), PR or CR. The estimated ORR and corresponding 90% confidence intervals based on the binomial distribution will be reported.
Measure:Disease control rate
Time Frame:Up to 1 year post-treatment
Safety Issue:
Description:Assessed by investigator as per RECIST v1.1.
Measure:Overall survival (OS)
Time Frame:From the date of start of treatment to the date of death due to any cause, will be assessed at 4, 6, 8,12 and 24 months
Safety Issue:
Description:Assessed by investigator as per RECIST v1.1. Will be analyzed using the Kaplan Meier method. Survival rate at 4, 6, 8, 12, 18 and 24 months and median OS will be estimated along with 95% confidence intervals from the Kaplan Meier distribution.
Measure:Incidence of adverse events (AEs)
Time Frame:Up to 30 days post-treatment
Safety Issue:
Description:Will be tabulated and presented. All AEs occurring during the study will be included in by-patient data listings and tabulated by organ class and preferred term. Adverse events will be summarized overall, by relationship and by severity. Events leading to death, serious (S)AE, and events resulting in treatment discontinuation will be tabulated. Individual patient laboratory parameter values and summary statistics over time will be prepared using descriptive statistics. Severity of select clinical laboratory measures will be determined using National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v5 criteria and grade 3 or 4 laboratory values will be presented in a separate patient listing.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:Sameek Roychowdhury

Last Updated

January 15, 2020