Clinical Trials /

Study of HQP1351 in Subjects With Refractory CML and Ph+ ALL

NCT04260022

Description:

A multi-center, open-label, randomized, phase Ib study to evaluate the pharmacokinetics (PK) of HQP1351 and to determine the recommended phase 2 dose (RP2D) of HQP1351 in subjects with CML chronic phase (CP), accelerated phase (AP) or blast phase (BP) or with Ph+ ALL, who have experienced resistance or intolerance to at least three tyrosine kinase inhibitors (TKIs).

Related Conditions:
  • Acute Lymphoblastic Leukemia
  • Chronic Myeloid Leukemia
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Study of HQP1351 in Subjects With Refractory CML and Ph+ ALL
  • Official Title: A Phase Ib Study of the Pharmacokinetics, Safety and Efficacy of Orally Administered HQP1351 in Subjects With Refractory Chronic Myeloid Leukemia (CML) and Ph+ Acute Lymphoblastic Leukemia (Ph+ ALL)

Clinical Trial IDs

  • ORG STUDY ID: HQP1351CU101
  • NCT ID: NCT04260022

Conditions

  • Leukemia, Myeloid, Chronic
  • Myeloid Leukemia
  • Chronic Myeloid Leukemia
  • Philadelphia Positive Acute Lymphoblastic Leukemia

Interventions

DrugSynonymsArms
Ascentage Pharma HQP1351 bioavailable inhibitorHQP1351 30mg

Purpose

A multi-center, open-label, randomized, phase Ib study to evaluate the pharmacokinetics (PK) of HQP1351 and to determine the recommended phase 2 dose (RP2D) of HQP1351 in subjects with CML chronic phase (CP), accelerated phase (AP) or blast phase (BP) or with Ph+ ALL, who have experienced resistance or intolerance to at least three tyrosine kinase inhibitors (TKIs).

Detailed Description

      This is a multi-center, open-label, randomized, phase Ib study to evaluate the PK of HQP1351
      and to determine the RP2D of HQP1351 in subjects with CML CP, AP or BP or with Ph+ ALL, who
      have experienced resistance or intolerance to at least three TKIs. The preliminary efficacy
      and safety of HQP1351 in these patients will be evaluated as well.

      A total of 30 patients will be randomized at 1:1:1 ratio into one of the three dose cohorts:
      30 mg every other day (QOD), 40 mg QOD, and 50 mg QOD, with 10 patients per dose cohort. The
      first cycle of 28 days is considered as the dose-limiting toxicity (DLT) observation period.
      If the incidence of DLTs exceeds 20% (2 patients) in 50 mg dose cohort during the first cycle
      of therapy, this dose cohort will be stopped. The randomization will be stratified to 4
      groups: T315I mutated CML-CP and CML-AP, T315I un-mutated CML-CP, T315I unmutated CML-AP, and
      CML-BP and Ph+ ALL to ensure that the subgroups are represented across all dose cohorts.
      Blood samples will be collected from each subject at specified time points to evaluate the PK
      of HQP1351. RP2D of HQP1351 will be determined based on the comprehensive analyses of the PK,
      safety, and efficacy data of the US patients treated with HQP1351, when compared with that in
      the Chinese patients.

      Eligible patients will have disease resistance to or intolerance to at least three TKIs, for
      patients with T315I mutation, resistance or intolerance to ponatinib alone is acceptable.

      Patients will be administered HQP1351 orally every other day (QOD) during a period of 28 days
      (1 cycle).
    

Trial Arms

NameTypeDescriptionInterventions
HQP1351 30mgExperimental
  • Ascentage Pharma HQP1351 bioavailable inhibitor
HQP1351 40mgExperimental
  • Ascentage Pharma HQP1351 bioavailable inhibitor
HQP1351 50mgExperimental
  • Ascentage Pharma HQP1351 bioavailable inhibitor

Eligibility Criteria

        Inclusion Criteria:

          -  Patients must have CML in any phase (CP, AP, or BP of any phenotype) or Ph+ ALL, with
             or without T315I mutation

          -  Be previously treated with and developed resistance or intolerance to at least three
             TKIs including ponatinib, imatinib, dasatinib, nilotinib, or bosutinib). For patients
             with a T315I mutation, resistance or intolerance to ponatinib alone is acceptable. For
             patients with cardiovascular and other risks that may not tolerate ponatinib treatment
             based on investigators' discretion, resistance or intolerance to at least three TKIs
             with or without ponatinib is acceptable.

               1. The definition of resistance to first-line TKI treatment refers to European
                  Leukemia Net (ELN) recommendations. The definitions are the same for patients in
                  CP, AP, BP and Ph+ ALL, and apply also to second-line treatment, when first-line
                  treatment was changed for intolerance. The patients must meet at least one
                  criterion.

                    1. Three months after the initiation of therapy: non-complete hematologic
                       response (CHR) and/or Ph+ >95%

                    2. Six months after the initiation of therapy: BCR-ABL1>10% and/or Ph+ >35%

                    3. Twelve months after the initiation of therapy: BCR-ABL1>1% and/or Ph+ >0%

                    4. Then, and at any time after the initiation of therapy: Loss of CHR, or loss
                       of complete cytogenetic response (CCyR), or confirmed loss of major
                       molecular response (MMR) (In 2 consecutive tests, of which one with a
                       BCR-ABL1 transcripts level≥1%), mutations, clonal chromosome abnormalities
                       in Ph+ cells (CCA/Ph+)

               2. The definition of resistance to second-line TKI treatment

                  a) For CML CP patients: the patients must meet at least one criterion as follows:

                  i.) Three months after the initiation of therapy: No CHR or Ph+ >95% or new
                  mutations

                  ii.) Six months after the initiation of therapy: BCR-ABL1>10% and/or Ph+ >65%
                  and/or new mutations

                  iii.) Twelve months after the initiation of therapy: BCR-ABL1>10% and/or Ph+ >35%
                  and/or new mutations

                  iv.) Then, and at any time after the initiation of therapy: Loss of CHR or loss
                  of CCyR, new mutations, confirmed loss of MMR (In 2 consecutive tests, of which
                  one with a BCR-ABL1 transcripts level≥1%), clonal chromosome abnormalities in Ph+
                  cells (CCA/Ph+)

                  b) For CML AP patients: the patients must meet at least one criterion as follows:

                  i.) Three months after the initiation of therapy: failure to achieve a major
                  hematologic response (MaHR)

                  ii.) At any time after the initiation of therapy, the loss of a MaHR, confirmed
                  in at least 2 consecutive analyses separated by at least 4 weeks

                  iii.) At any time after the initiation of therapy, the development of new BCR-ABL
                  kinase domain mutations in the absence of a MaHR

                  c) For CML BP and Ph+ ALL patients: the patients must meet at least one criterion
                  as follows:

                  i) One month after the initiation of therapy: failure to achieve a MaHR

                  ii) At any time after the initiation of therapy, the loss of a MaHR, confirmed in
                  at least 2 consecutive analyses separated by at least 1week

                  iii) At any time after the initiation of therapy, the development of new BCR-ABL
                  kinase domain mutations in the absence of a MaHR

               3. Intolerance to TKIs is defined as:

                    1. Non-hematological AEs: patients with grade 3 or 4 toxicity during TKIs
                       treatment, or with persistent grade 2 toxicity, unresponsive to optimal
                       management, including dose adjustments in the absence of a CCyR for CP
                       patients or MaHR for AP/BP or Ph+ ALL patients

                    2. Hematological AEs: patients with grade 3 or 4 toxicity during TKIs
                       treatment, that is recurrent after unresponsive after optimal management,
                       including dose adjustments in the absence of a CCyR for CP patients or MaHR
                       for AP/BP or Ph+ ALL patients

          -  Patients providing written informed consent before initiation of any study-related
             activities

          -  Eastern Cooperative Oncology Group (ECOG) performance status ≤2

          -  Minimum life expectancy of 3 months or more

          -  Patients with adequate organ function as defined below:

               1. Creatinine < 2 × upper limit of normal (ULN); or, creatinine > 2 × ULN, with 24h
                  glomerular filtration rate (GFR) ≥ 30 mL/min (Cockcroft-Gault)

               2. Serum albumin ≥ 3.0 g/dL

               3. Total bilirubin < 1.5 × ULN

               4. Aspartate aminotransferase (AST [Serum glutamic oxaloacetic transaminase (SGOT)])
                  and alanine aminotransferase (ALT [serum glutamate-pyruvate transaminase (SGPT)])
                  < 3 × ULN for institution (<5×ULN if liver involvement with leukemia)

               5. Serum amylase and lipase ≤ 1.5 × ULN

               6. Prothrombin time (PT) ≤ 1.5 × ULN

          -  Heart function: Left ventricular ejection fraction (LVEF) > 50%

          -  Normal QT interval corrected Fridericia (QTcF) interval on screening electrocardiogram
             (ECG) evaluation: male ≤450ms, female ≤470ms

          -  For females of childbearing potential, a negative pregnancy test must be established
             before enrollment. And the eligible female and male patients with childbearing
             potential must agree to use an effective form of contraception with their sexual
             partners throughout participation in this study

          -  Ability to comply with study procedures, in the Investigator's opinion

        Exclusion Criteria:

          -  Received TKI therapy within 5 half-lives or 7 days prior to first dose of HQP1351,
             whichever is shorter, or any adverse events (AEs) (except alopecia and pigmentation)
             not recovered to CTCAE v5.0 grade 0-1 due to any other treatments

          -  Received other therapies as follows:

               1. For CP and AP patients, received hydroxyurea or anagrelide within 24 hours prior
                  to the first dose of HQP1351; or, interferon, immunotherapy or cytarabine within
                  14 days prior to the first dose of HQP1351; or, any other radiotherapy, cytotoxic
                  chemotherapy or investigational therapy within 28 days prior to receiving the
                  first dose of HQP1351

               2. For BP patients, received chemotherapy within 7 days prior to the first dose of
                  HQP1351

               3. For Ph+ ALL patients, received corticosteroids within 24 hours before the first
                  dose of HQP1351, or received chemotherapy within 7 days prior to the first dose
                  of HQP1351

               4. Patients who are currently receiving treatment with a medication that has the
                  potential to interact with HQP1351

               5. Patients who had been treated with HQP1351

               6. Patients requiring immunosuppressive therapy other than short time of steroid

          -  Impairment of gastrointestinal (GI) function or GI disease that may significantly
             alter absorption of study drugs

          -  Patients with cardiovascular diseases, including uncontrolled high blood pressure
             (HBP) (that is blood pressure >140/90mmHg.); or, receiving drugs that can cause
             prolonged QT interval. The patients with well controlled HBP can be considered to be
             included. (the "well controlled HBP" is defined as: HBP can be ≤ 140/90mmHg with
             antihypertensive treatment). Those requiring 3 or more antihypertensive medications
             should be discussed with the medical monitor.

          -  Have clinically significant, uncontrolled, or active cardiovascular disease,
             specifically including, but not restricted to:

               1. Any history of myocardial infarction (MI) within 6 months or unstable angina
                  within 3 months

               2. Any history of cerebrovascular accident within 1 year, or transient ischemic
                  attack (TIA) within 3 months

               3. Any history of peripheral vascular infarction, including visceral infarction
                  within 6 months

               4. Congestive heart failure (CHF) (New York Heart Association [NYHA] class III or
                  IV) within 6 months prior to enrollment, or left ventricular ejection fraction
                  (LVEF) less than lower limit of normal, per local institutional standards, within
                  6 months prior to enrollment

               5. History of clinically significant (as determined by the treating physician)
                  atrial arrhythmia or any history of ventricular arrhythmia

               6. Venous thromboembolism, including deep venous thrombosis or pulmonary embolism,
                  within 3 months prior to enrollment. Patients who have experienced a venous
                  thromboembolic event should only be eligible if the condition is well controlled
                  with optimal intervention (as determined by the treating physician). Continued
                  prophylactic anticoagulation is acceptable.

               7. Patients with revascularization procedures including cardiac bypass within the 6
                  months and stenting within the past 3 months should be excluded.

          -  Have history of autologous or allogeneic stem cell transplant, or with active
             graft-versus-host disease (GVHD), or active immune suppression in recent 6 months
             prior to informed consent date or active immune suppression in recent 6 months prior
             to informed consent date

          -  CML CP patients with CCyR

          -  Patients who have a significant bleeding disorder unrelated to CML or Ph+ ALL

          -  Patients who had a major surgery within 4 weeks prior to study entry or have not
             recovered from side effects of such surgery which the Investigator considers not
             appropriate for enrollment

          -  Cytologically confirmed central nervous system (CNS) involvement (if asymptomatic,
             spinal fluid examination is not necessary prior to first treatment)

          -  Patients with another primary malignancy within 1 years of study entry. Patients with
             nonmelanoma skin cancer or carcinoma in situ of any type are not excluded if they have
             undergone complete resection and are considered disease-free at the time of study
             entry.

          -  Have ongoing or active infection, including known history of immunodeficiency virus
             (HIV) or HIV antibody positive, hepatitis B virus (HBV) or HBsAg positive, hepatitis C
             virus (HCV). Patients who have positive HCV antibody must have an undetectable HCV
             viral load.

          -  Patients who have poorly controlled diabetes, defined as HbA1C values of > 7.5%.
             Patients with pre-existing, well-controlled diabetes are not excluded.

          -  Known allergy to any components in the study drug

          -  Pregnant or lactating

          -  Patients who have any conditions or illness that, according to the opinions of the
             investigator or the medical monitor, would comprise patient safety or interfere with
             the evaluation of safety and efficacy to the study drug
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Maximum Plasma Concentration (Cmax) of HQP1351
Time Frame:28 days
Safety Issue:
Description:To evaluate the Maximum Plasma Concentration (Cmax) of HQP1351

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Ascentage Pharma Group Inc.

Trial Keywords

  • T315I mutation
  • Chronic Phase
  • Accelerated Phase
  • Blast Phase

Last Updated

February 12, 2021